Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005-2006).
OBJECTIVE
To describe the evolving epidemiology, management, and risk factors for death of invasive Candida infections in intensive care units (ICUs).


METHODS
Prospective, observational, national, multicenter study.


METHODS
One hundred eighty ICUs in France.


METHODS
Between October 2005 and May 2006, 300 adult patients with proven invasive Candida infection who received systemic antifungal therapy were included.


METHODS
None.


RESULTS
One hundred seven patients (39.5%) with isolated candidemia, 87 (32.1%) with invasive candidiasis without documented candidemia, and 77 (28.4%) with invasive candidiasis and candidemia were eligible. In 37% of the cases, candidemia occurred within the first 5 days after ICU admission. C. albicans accounted for 57.0% of the isolates, followed by C. glabrata (16.7%), C. parapsilosis (7.5%), C. krusei (5.2%), and C. tropicalis (4.9%). In 17.1% of the isolates, the causative Candida was less susceptible or resistant to fluconazole. Fluconazole was the empirical treatment most commonly introduced (65.7%), followed by caspofungin (18.1%), voriconazole (5.5%), and amphotericin B (3.7%). After identification of the causative species and susceptibility testing results, treatment was modified in 86 patients (31.7%). The case fatality ratio in ICU was 45.9% and did not differ significantly according to the type of episode. Multivariate analysis showed that factors independently associated with death in ICU were type 1 diabetes mellitus (odds ratio [OR] 4.51; 95% confidence interval [CI] 1.72-11.79; p = 0.002), immunosuppression (OR 2.63; 95% CI 1.35-5.11; p = 0.0045), mechanical ventilation (OR 2.54; 95% CI 1.33-4.82; p = 0.0045), and body temperature >38.2 degrees C (reference, 36.5-38.2 degrees C; OR 0.36; 95% CI 0.17-0.77; p = 0.008).


CONCLUSIONS
More than two thirds of patients with invasive candidiasis in ICU present with candidemia. Non-albicans Candida species reach almost half of the Candida isolates. Reduced susceptibility to fluconazole is observed in 17.1% of Candida isolates. Mortality of invasive candidiasis in ICU remains high.
Leroy
Olivier
O
Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Gustave Dron, Tourcoing, France. oleroy@ch-tourcoing.fr
Gangneux
Jean-Pierre
JP
Montravers
Philippe
P
Mira
Jean-Paul
JP
Gouin
François
F
Sollet
Jean-Pierre
JP
Carlet
Jean
J
Reynes
Jacques
J
Rosenheim
Michel
M
Regnier
Bernard
B
Lortholary
Olivier
O