title: Fungal colonization and/or infection in non-neutropenic critically ill patients: results of the EPCAN observational study.
abstract: The purpose of this paper is to determine the incidence of fungal colonization and infection in non-neutropenic critically ill patients and to identify factors favoring infection by Candida spp. A total of 1,655 consecutive patients (>18 years of age) admitted for > or = 7 days to 73 medical-surgical Spanish intensive care units (ICUs) participated in an observational prospective cohort study. Surveillance samples were obtained once a week. One or more fungi were isolated in different samples in 59.2% of patients, 94.2% of which were Candida spp. There were 864 (52.2%) patients with Candida spp. colonization and 92 (5.5%) with proven Candida infection. In the logistic regression analysis risk factors independently associated with Candida spp. infection were sepsis (odds ratio [OR] = 8.29, 95% confidence interval [CI] 5.07-13.6), multifocal colonization (OR = 3.49, 95% CI 1.74-7.00), surgery (OR = 2.04, 95% CI 1.27-3.30), and the use of total parenteral nutrition (OR = 4.37, 95% CI 2.16-8.33). Patients with Candida spp. infection showed significantly higher in-hospital and intra-ICU mortality rates than those colonized or non-colonized non-infected (P < 0.001). Fungal colonization, mainly due to Candida spp., was documented in nearly 60% of non-neutropenic critically ill patients admitted to the ICU for more than 7 days. Proven candidal infection was diagnosed in 5.5% of cases. Risk factors independently associated with Candida spp. infection were sepsis, multifocal colonization, surgery, and the use of total parenteral nutrition.
authors.affiliation: Servicio de Ciudados Críticos y Urgencias, Hospital Universitario de Valme, Universidad de Sevilla, Carretera de Cádiz s/n, 41014 Sevilla, Spain. cleong@telefonica.net
authors.forename: C
authors.initials: C
authors.lastname: León
authors.forename: F
authors.initials: F
authors.lastname: Alvarez-Lerma
authors.forename: S
authors.initials: S
authors.lastname: Ruiz-Santana
authors.forename: M A
authors.initials: MA
authors.lastname: León
authors.forename: J
authors.initials: J
authors.lastname: Nolla
authors.forename: R
authors.initials: R
authors.lastname: Jordá
authors.forename: P
authors.initials: P
authors.lastname: Saavedra
authors.forename: M
authors.initials: M
authors.lastname: Palomar