title: Temporal trends, risk factors and outcomes in albicans and non-albicans candidaemia: an international epidemiological study in four multidisciplinary intensive care units.
abstract: This multicentre study (i) evaluated geographic and temporal changes in candidaemia ecology in the critically ill, (ii) identified risk factors associated with non-albicans candidaemia and (iii) examined the association of Candida ecology with mortality. A retrospective cohort study of patients who developed candidaemia in four general Intensive Care Units located in Australia, Greece, Belgium and Brazil was performed. Two hundred Candida organisms were identified by positive blood culture in 189 patients, including 112 Candida albicans (56.0%), 38 Candidaglabrata (19.0%), 21 Candidaparapsilosis (10.5%), 18 Candidatropicalis (9.0%), 6 Candidakrusei (3.0%), 1 Candidafamata (0.5%), 1 Candidazeylanoides (0.5%) and 3 non-differentiated Candida spp. (1.5%). No trend towards increased non-albicans species over the study period (P=0.68) or by geographic area (P=0.35) was demonstrated. Independent risk factors for non-albicans candidaemia included: female gender [odds ratio (OR) 2.09, 95% confidence interval (CI) 1.13-3.86] and increased central venous catheter days (OR 1.16 per 5-day interval, 95% CI 1.05-1.28). Mortality in the non-albicans group was non-significantly higher than in the albicans group (65% vs. 53%; P=0.10). This study is unique in that a large number of intensive care candidaemias in four geographically diverse units have been studied.
authors.affiliation: Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Butterfield Street, Herston 4029, Brisbane, Australia. Anthony_Holley@health.qld.gov.au
authors.forename: Anthony
authors.initials: A
authors.lastname: Holley
authors.forename: Joel
authors.initials: J
authors.lastname: Dulhunty
authors.forename: Stijn
authors.initials: S
authors.lastname: Blot
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
authors.forename: Suzana
authors.initials: S
authors.lastname: Lobo
authors.forename: Craig
authors.initials: C
authors.lastname: Dancer
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.forename: George
authors.initials: G
authors.lastname: Dimopoulos
mesh_terms: D000368:Aged; D001315:Australia; D001530:Belgium; D001938:Brazil; D002175:Candida / Q000145:classification / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology* / Q000401:mortality; D002408:Catheters, Indwelling / Q000009:adverse effects; D016638:Critical Illness; D005260:Female; D016469:Fungemia / Q000453:epidemiology* / Q000401:mortality; D006115:Greece; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors