title: Septic shock due to candidemia: outcomes and predictors of shock development.
abstract: BACKGROUND
  The present report describes the outcomes of a cohort of patients with Candida induced septic shock.
  
  
  METHODS
  Retrospective analysis of individuals who had at least one positive blood culture for Candida species ≥ 48 h after ICU admission. Data from patients that developed septic shock within 48 hr of the positive blood culture were compared to non-shock candidemic patients. Patients with a concomitant bacteremia and/or endocarditis were excluded.
  
  
  RESULTS
  Fifteen patients with Candida induced septic shock were studied and compared to 35 candidemic patients without shock. Overall mortality was 76% (87 % among those who had shock). A high proportion of non-albicans Candida species causing fungemia (74%) was observed. All patients with shock were receiving antibiotics but not antifungal treatment at the time of shock development, eight were on parenteral nutrition, six on steroids and nine had a cancer history. High dose fluconazole was the most common initial treatment provided. Four patients died before receiving any antifungal treatment. Time in ICU before the development of candidemia was identified as a predictor of shock development (higher chance if fungemia developed < 7 days after ICU admission).
  
  
  CONCLUSIONS
  Septic shock due to invasive candidiasis is a near fatal condition. No conventional risk factors were identified to predict shock development other than time (shorter) spent in ICU before the development of candidemia. We encourage clinicians to consider the initiation of appropriate empiric antifungal treatment in high-risk patients who develop septic shock while on antimicrobial treatment.
  
  
  BACKGROUND
  Septic shock; Candidemia; Outcome; Predictor.
authors.affiliation: Section of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, USA.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Guzman
authors.forename: Ronny
authors.initials: R
authors.lastname: Tchokonte
authors.forename: Jack D
authors.initials: JD
authors.lastname: Sobel