title: Comparison of the epidemiology, risk factors, outcome and degree of organ failures of patients with candidemia acquired before or during ICU treatment.
abstract: BACKGROUND
  The aim of this study was to compare the epidemiology, risk factors, severity and outcome of two types of ICU-treated candidemias: namely, ICU-acquired candidemia (acquired after 48-hour ICU stay) (ICUAC group), and those needing ICU treatment for candidemia acquired before ICU admission or during the first 48-hour ICU stay (non-ICUAC group).
  
  
  METHODS
  A retrospective cohort study was conducted between 2000 and 2009 in a mixed tertiary ICU among patients with blood-culture-confirmed candidemia.
  
  
  RESULTS
  The study involved 82 patients (53 men). The ICUAC group consisted of 38 patients (46.3%) and the non- ICUA group included 44 patients (53.6). The ICUAC group had undergone previous surgery more often and had ICU stays that were 3.7 times longer than the non-ICUAC group, whose members more often had co-morbidities (95.6% versus 73.7%, P = 0.001). The ICUAC group had significantly more frequent organ failures with cardiovascular, renal, central nervous and coagulation systems than the non-ICUAC group. ICU, hospital and one-year mortality rates did not differ between the groups (23%, 36.8% and 65.8%, respectively, in the ICUAC group and 26%, 44.4% and 64.4%, respectively, in the non-ICUAC group). Among patients with APACHE II scores greater than 25, the ICUAC group had lower one-year mortality (65.0% versus 87.5%). Among patients with APACHE II scores of 25 or less, the ICUAC group had higher mortality (66.7% versus 50.0). Candida albicans was most common cause of candidemia in both groups (76.3% and 68.9%, respectively).
  
  
  CONCLUSIONS
  More than half of the ICU-treated candidemias were acquired prior to admission to the ICU. Patients with ICU- and non-ICU-acquired candidemias had different risk factors and different needs for ICU resources. Hospital mortality was similar in both groups; however, the groups had different mortality rates when the severity of disease and underlying diseases were taken into account.
authors.affiliation: Department of Infection Control, Oulu University Hospital, Kajaanintie 50, Oulu, FIN-90029 OYS, Finland. pekka.ylipalosaari@oulu.fi
authors.forename: Pekka
authors.initials: P
authors.lastname: Ylipalosaari
authors.forename: Tero I
authors.initials: TI
authors.lastname: Ala-Kokko
authors.forename: Juha
authors.initials: J
authors.lastname: Karhu
authors.forename: Markku
authors.initials: M
authors.lastname: Koskela
authors.forename: Jouko
authors.initials: J
authors.lastname: Laurila
authors.forename: Pasi
authors.initials: P
authors.lastname: Ohtonen
authors.forename: Hannu
authors.initials: H
authors.lastname: Syrjälä
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology* / Q000382:microbiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D000935:Antifungal Agents