title: Impact of invasive fungal infection on outcomes of severe sepsis: a multicenter matched cohort study in critically ill surgical patients.
abstract: BACKGROUND
  Fungal infection is increasingly common in critical illness with severe sepsis, but the influence of invasive fungal infection (IFI) on severe sepsis is not well understood. The aim of this study was to investigate the impact that IFI has on the outcomes of critically ill surgical patients with severe sepsis in China by means of matched cohort analysis; we also evaluated the epidemiologic characteristics of IFI in this population.
  
  
  METHODS
  Records for all admissions to 10 university hospital surgical intensive care units (ICUs) from December 2004 to November 2005 were reviewed. Patients who met criteria for severe sepsis were included. IFI was identified using established criteria based on microbiologic or histological evidence. A matched cohort study was conducted to analyze the relationship between IFI and outcomes of severe sepsis.
  
  
  RESULTS
  A total of 318 patients with severe sepsis were enrolled during the study period, of whom 90 (28.3%) were identified as having IFI. A total of 100 strains of fungi (58% Candida albicans) were isolated from these patients. Independent risk factors for IFI in patients with severe sepsis included mechanical ventilation (>3 days), Acute Physiology and Chronic Health Evaluation score, coexisting infection with both gram-positive and gram-negative bacteria, and urethral catheterization (>3 days). Compared with the control cohort, IFI was associated with increased hospital mortality (P < 0.001), high hospital costs (P = 0.038), and prolonged stay in the ICU (P < 0.001) and hospital (P = 0.020).
  
  
  CONCLUSIONS
  IFI is frequent in patients with severe sepsis in surgical ICUs and is associated with excess risk for hospital mortality, longer ICU and hospital stays, and greater consumption of medical resources.
authors.affiliation: Department of Anesthesiology and Intensive Care Unit, the First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, 310003, Hangzhou, China.
authors.forename: Guo-Hao
authors.initials: GH
authors.lastname: Xie
authors.forename: Xiang-Ming
authors.initials: XM
authors.lastname: Fang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Fang
authors.forename: Xin-Min
authors.initials: XM
authors.lastname: Wu
authors.forename: Yu-Hong
authors.initials: YH
authors.lastname: Jin
authors.forename: Jun-Lu
authors.initials: JL
authors.lastname: Wang
authors.forename: Qu-Lian
authors.initials: QL
authors.lastname: Guo
authors.forename: Miao-Ning
authors.initials: MN
authors.lastname: Gu
authors.forename: Qiu-Ping
authors.initials: QP
authors.lastname: Xu
authors.forename: Dong-Xin
authors.initials: DX
authors.lastname: Wang
authors.forename: Shang-Long
authors.initials: SL
authors.lastname: Yao
authors.forename: Shi-Ying
authors.initials: SY
authors.lastname: Yuan
authors.forename: Zhao-Hui
authors.initials: ZH
authors.lastname: Du
authors.forename: Yun-Bo
authors.initials: YB
authors.lastname: Sun
authors.forename: Hai-Hong
authors.initials: HH
authors.lastname: Wang
authors.forename: Shui-Jing
authors.initials: SJ
authors.lastname: Wu
authors.forename: Bao-Li
authors.initials: BL
authors.lastname: Cheng
mesh_terms: D018806:APACHE; D000368:Aged; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009181:Mycoses / Q000145:classification / Q000150:complications*; D011183:Postoperative Complications; D012307:Risk Factors; D018805:Sepsis / Q000145:classification / Q000150:complications* / Q000628:therapy; D012720:Severity of Illness Index