title: Factors associated with candidemia caused by non-albicans Candida species versus Candida albicans in the intensive care unit.
abstract: BACKGROUND
  Candida albicans has been the most common cause of fungal bloodstream infections (BSIs) in intensive care units (ICUs); however, infections due to non-albicans Candida species have been increasing in prevalence. We examined factors associated with BSIs due to non-albicans Candida species, compared with C. albicans BSIs, in an ICU patient population.
  
  
  METHODS
  For our case-comparator study, we identified consecutive adult ICU patients with BSIs due to non-albicans Candida species or C. albicans at 2 tertiary care hospitals during the period 1995-2005. Data collected included demographic characteristics, comorbidities, exposure to antibiotics and antifungals, and ICU-related factors, such as total parenteral nutrition, blood product transfusions, invasive procedures, central venous catheter use, hemodialysis, and mechanical ventilation. We built a multivariable logistic regression model that identified variables that differentiate BSIs due to non-albicans Candida species from BSIs due to C. albicans.
  
  
  RESULTS
  There were 67 patients with BSIs due to non-albicans Candida species and 79 patients with C. albicans BSIs. Variables were adjusted for time at risk. In multivariable models, factors associated with an increased risk of BSIs due to non-albicans Candida species, compared with C. albicans BSIs, included fluconazole exposure (odds ratio, 11.6; 95% confidence interval, 2.28-58.8), central venous catheter exposure (odds ratio, 1.95; 95% confidence interval, 1.10-3.47), and mean number of antibiotics per day (odds ratio, 2.31; 95% confidence interval, 0.71-7.54). Total parenteral nutrition exposure was associated with a decreased risk (odds ratio, 0.16; 95% confidence interval, 0.05-0.47) of BSIs due to non-albicans Candida species, compared with C. albicans BSIs. Duration of stay in the ICU was not significantly different between the 2 groups. Specific antibiotics, such as vancomycin and piperacillin-tazobactam, were not independently associated with BSI due to non-albicans Candida species.
  
  
  CONCLUSIONS
  Receipt of fluconazole and central venous catheter exposure were associated with an increased risk of BSI due to non-albicans Candida species, and total parenteral nutrition was associated with a decreased risk of BSI due to non-albicans Candida species, compared with BSI due to C. albicans. Patients without characteristics of infection due to non-albicans Candida species might benefit from empirical antifungal therapy with fluconazole.
authors.affiliation: Division of Geographic Medicine and Infectious Diseases, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA. jchow@tufts-nemc.org
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Chow
authors.forename: Yoav
authors.initials: Y
authors.lastname: Golan
authors.forename: Robin
authors.initials: R
authors.lastname: Ruthazer
authors.forename: Adolf W
authors.initials: AW
authors.lastname: Karchmer
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Carmeli
authors.forename: Deborah
authors.initials: D
authors.lastname: Lichtenberg
authors.forename: Varun
authors.initials: V
authors.lastname: Chawla
authors.forename: Janet
authors.initials: J
authors.lastname: Young
authors.forename: Susan
authors.initials: S
authors.lastname: Hadley
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002176:Candida albicans / Q000302:isolation & purification*; D002177:Candidiasis / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D005260:Female; D015725:Fluconazole / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole