title: Septic shock attributed to Candida infection: importance of empiric therapy and source control.
abstract: BACKGROUND
  Delayed treatment of candidemia has previously been shown to be an important determinant of patient outcome. However, septic shock attributed to Candida infection and its determinants of outcome have not been previously evaluated in a large patient population.
  
  
  METHODS
  A retrospective cohort study of hospitalized patients with septic shock and blood cultures positive for Candida species was conducted at Barnes-Jewish Hospital, a 1250-bed urban teaching hospital (January 2002-December 2010).
  
  
  RESULTS
  Two hundred twenty-four consecutive patients with septic shock and a positive blood culture for Candida species were identified. Death during hospitalization occurred among 155 (63.5%) patients. The hospital mortality rate for patients having adequate source control and antifungal therapy administered within 24 hours of the onset of shock was 52.8% (n = 142), compared to a mortality rate of 97.6% (n = 82) in patients who did not have these goals attained (P < .001). Multivariate logistic regression analysis demonstrated that delayed antifungal treatment (adjusted odds ratio [AOR], 33.75; 95% confidence interval [CI], 9.65-118.04; P = .005) and failure to achieve timely source control (AOR, 77.40; 95% CI, 21.52-278.38; P = .001) were independently associated with a greater risk of hospital mortality.
  
  
  CONCLUSIONS
  The risk of death is exceptionally high among patients with septic shock attributed to Candida infection. Efforts aimed at timely source control and antifungal treatment are likely to be associated with improved clinical outcomes.
authors.affiliation: Pulmonary and Critical Care Division, Washington University School of Medicine, St. Louis, MO 63110, USA. kollef@dom.wustl.edu
authors.forename: Marin
authors.initials: M
authors.lastname: Kollef
authors.forename: Scott
authors.initials: S
authors.lastname: Micek
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hampton
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Doherty
authors.forename: Anand
authors.initials: A
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D001769:Blood / Q000382:microbiology; D002175:Candida / Q000302:isolation & purification*; D002177:Candidiasis / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome; D014505:Urban Population
chemical_list: D000935:Antifungal Agents