Impact of invasive fungal infection on outcomes of severe sepsis: a multicenter matched cohort study in critically ill surgical patients.
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.
Xie
Guo-Hao
GH
Department of Anesthesiology and Intensive Care Unit, the First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, 310003, Hangzhou, China.
Fang
Xiang-Ming
XM
Fang
Qiang
Q
Wu
Xin-Min
XM
Jin
Yu-Hong
YH
Wang
Jun-Lu
JL
Guo
Qu-Lian
QL
Gu
Miao-Ning
MN
Xu
Qiu-Ping
QP
Wang
Dong-Xin
DX
Yao
Shang-Long
SL
Yuan
Shi-Ying
SY
Du
Zhao-Hui
ZH
Sun
Yun-Bo
YB
Wang
Hai-Hong
HH
Wu
Shui-Jing
SJ
Cheng
Bao-Li
BL
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