title: Candidemia after cardiac surgery in the intensive care unit: an observational study.
abstract: Candidemia is a well-recognized complication of hospital stay, especially in critically ill patients. There is not a general consensus that predictors for candidemia in cardiosurgical intensive care unit (cICU) are different from a general ICU and it has been reported that cardiopulmonary bypass time is a specific risk factor in the cICU. We performed a prospective study to evaluate the main predictors for candidemia in patients admitted to the cICU. Included patients were adults admitted between July 2005 and December 2007 with an ICU-length of stay (ICU-LOS) ≥48 hours after cardiac surgery. Exclusion criteria were solid organ or bone marrow transplants, previous diagnosis of candidemia or other invasive infections and ICU stay before surgery. A multiple regression analysis was performed to identify the risk factors. Among 1955 patients admitted to the cICU, 345 were enrolled. Only 26 patients (1.3%) had candidemia after an ICU-LOS of 20 days (inter-quartile range, IQR 8-49 days). Total parenteral nutrition [odds ratio (OR)=9.56; confidence interval (CI)=1.741-52.534], severe sepsis (OR=4.20; CI=1.292-13.667), simplified acute physiology score II (OR=1.16; CI=1.052-1.278) and ICU-LOS >20 days (OR=6.38; CI=1.971-20.660) were independent predictors of candidemia. Patients undergoing cardiac surgery developed candidemia late after cICU admission and the independent predictors were similar to the general ICU.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, San Giovanni Battista Hospital, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy. daniela.pasero@unito.it
authors.forename: Daniela
authors.initials: D
authors.lastname: Pasero
authors.forename: Francesco Giuseppe
authors.initials: FG
authors.lastname: De Rosa
authors.forename: Nerlep Kaur
authors.initials: NK
authors.lastname: Rana
authors.forename: Lucina
authors.initials: L
authors.lastname: Fossati
authors.forename: Alessandra
authors.initials: A
authors.lastname: Davi
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Perri
authors.forename: V Marco
authors.initials: VM
authors.lastname: Ranieri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058387:Candidemia / Q000382:microbiology* / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000382:microbiology* / Q000401:mortality; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007558:Italy; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors