title: Candida infection and colonization among trauma patients.
abstract: BACKGROUND
  Data on Candida infection among critically ill trauma patients are limited and not recently updated. Here we study the epidemiology and economic impact of Candida and examine potential risk factors for Candida infection in this population.
  
  
  METHODS
  In this 5-year retrospective study, all severely injured patients with ≥4 days of intensive care unit stay were included, with the primary outcome being Candida infection. We identified 3 distinct patient groups: 1) The Candida infection, 2) The Candida colonization and 3) the Candida-free group. All comparisons between groups with p-values ≤0.2 from the univariate analysis were entered into stepwise logistic regression to identify independent risk factors for candidiasis.
  
  
  RESULTS
  374 patients were included. Upon comparisons between groups, candidiasis patients received significantly more blood transfusions (p=0.013), antibiotics (p=0.005), and total parenteral nutrition (TPN) (p=0.004), had a longer duration of mechanical ventilation (MV) (p=0.008) and underwent more laparotomy procedures than Candida free patients (56.5% versus 16.4%; p<0.001). Surgical complications (13% versus 1.4%; p=0.013), injury of the upper (13% versus 0.9%; p=0.007) and lower gastrointestinal tract (8.7% versus 0.9%; p=0.048), and bacterial wound or intra-abdominal infections (17.4% versus 1.9%; p=0.004) were also more common in candidiasis patients. Upon multivariate analysis, patients receiving TPN had 7-fold higher odds for developing candidiasis (Odds ratio [OR]: 7.2; 95% Confidence interval [CI]: 2.6-19.4; p=0.0001). Other predisposing factors included laparotomy (OR: 3.8, 95% CI: 1.5-9.9; p=0.0057) and female gender (OR: 5.7; 95% CI: 2.1-15.6; p=0.0007). Average total hospital charges were higher for patients with Candida infection compared to patients with Candida colonization or without a positive Candida culture.
  
  
  CONCLUSIONS
  TPN, laparotomy, and female gender independently predict the development of candidiasis among trauma patients. Severely injured women requiring laparotomy and TPN therapy should be carefully managed for the possibility of increased risk for candidiasis.
authors.affiliation: Division of Trauma Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Dimitra
authors.initials: D
authors.lastname: Manolakaki
authors.forename: George
authors.initials: G
authors.lastname: Velmahos
authors.forename: Themistoklis
authors.initials: T
authors.lastname: Kourkoumpetis
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Hasan B
authors.initials: HB
authors.lastname: Alam
authors.forename: Marc M
authors.initials: MM
authors.lastname: De Moya
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Mylonakis
mesh_terms: D000328:Adult; D000368:Aged; D002175:Candida / Q000302:isolation & purification*; D002177:Candidiasis / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology; D002353:Carrier State / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology; D016638:Critical Illness; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014947:Wounds and Injuries / Q000150:complications*