title: Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study.
abstract: OBJECTIVE
  To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection.
  
  
  METHODS
  A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge.
  
  
  METHODS
  EPIC II included 1265 intensive care units in 76 countries.
  
  
  METHODS
  Patients in participating intensive care units on study day.
  
  
  METHODS
  None.
  
  
  RESULTS
  Of the 14,414 patients in EPIC II, 99 patients had Candida bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstream infections. Candida albicans (n = 70) was the predominant species. Primary therapy included monotherapy with fluconazole (n = 39), caspofungin (n = 16), and a polyene-based product (n = 12). Combination therapy was infrequently used (n = 10). Compared with patients with Gram-positive (n = 420) and Gram-negative (n = 264) bloodstream infections, patients with candidemia were more likely to have solid tumors (p < .05) and appeared to have been in an intensive care unit longer (14 days [range, 5-25 days], 8 days [range, 3-20 days], and 10 days [range, 2-23 days], respectively), but this difference was not statistically significant. Severity of illness and organ dysfunction scores were similar between groups. Patients with Candida bloodstream infections, compared with patients with Gram-positive and Gram-negative bloodstream infections, had the greatest crude intensive care unit mortality rates (42.6%, 25.3%, and 29.1%, respectively) and longer intensive care unit lengths of stay (median [interquartile range]) (33 days [18-44], 20 days [9-43], and 21 days [8-46], respectively); however, these differences were not statistically significant.
  
  
  CONCLUSIONS
  Candidemia remains a significant problem in intensive care units patients. In the EPIC II population, Candida albicans was the most common organism and fluconazole remained the predominant antifungal agent used. Candida bloodstream infections are associated with high intensive care unit and hospital mortality rates and resource use.
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care, The University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, FL, USA. dkett@med.miami.edu
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Kett
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Echeverria
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002176:Candida albicans; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology*; D000077336:Caspofungin; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D055666:Lipopeptides; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D015725:Fluconazole; D000077336:Caspofungin