Effects of nosocomial candidemia on outcomes of critically ill patients.
OBJECTIVE
To determine whether nosocomial candidemia is associated with increased mortality in intensive care unit (ICU) patients.


METHODS
We performed a retrospective (1992 to 2000) cohort study of 73 ICU patients with candidemia and 146 matched controls. Controls were matched based on disease severity as measured by the Acute Physiology and Chronic Health Evaluation (APACHE) II score (+/- 1 point), diagnostic category, and length of ICU stay before onset of candidemia.


RESULTS
In comparison with the control group, patients with candidemia developed more acute respiratory failure (97% [n = 71] vs. 88% [n = 129], P = 0.03) during their ICU stay. They were mechanically ventilated for a longer period (29 +/- 26 days vs. 19 +/- 19 days, P<0.01) and had a longer stay in the ICU (36 +/- 33 days vs. 25 +/- 23 days, P = 0.02) as well as in the hospital (77 +/- 81 days vs. 64 +/- 69 days, P = 0.04). There was no difference in in-hospital mortality between the groups (48% [n = 35] vs. 43% [n = 62], P = 0.44), a difference of 5% (95% confidence interval [CI]: -8% to 19%). In a multivariate analysis, older age (hazard ratio [HR] = 1.13 per 10 years; 95% CI: 1.04 to 1.23; P = 0.004), acute renal failure (HR = 1.4; 95% CI: 1.1 to 2.0; P = 0.02), and unfavorable APACHE II scores (HR = 1.10 per 5 points; 95% CI: 1.00 to 1.20; P = 0.05) were independent predictors of mortality. Candidemia was not associated with mortality in a model that adjusted for these factors (HR = 0.9; 95% CI: 0.7 to 1.2; P = 0.53).


CONCLUSIONS
Nosocomial candidemia does not adversely affect the outcome in ICU patients in whom mortality is attributable to age, the severity of underlying disease, and acute illness.
Blot
Stijn I
SI
Department of Intensive Care, Ghent University Hospital, Gent, Belgium. stijn.blot@rug.ac.be
Vandewoude
Koenraad H
KH
Hoste
Eric A
EA
Colardyn
Francis A
FA
D018806:APACHE; D000328:Adult; D000368:Aged; D002177:Candidiasis / Q000401:mortality* / Q000635:transmission; D016022:Case-Control Studies; D015331:Cohort Studies; D016638:Critical Illness; D003428:Cross Infection / Q000401:mortality* / Q000635:transmission; D016469:Fungemia / Q000401:mortality* / Q000635:transmission; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D015996:Survival Rate