title: Epidemiology of invasive fungal infections in the intensive care unit: results of a multicenter Italian survey (AURORA Project).
abstract: OBJECTIVE
  The aims of this study are to evaluate the epidemiology of invasive fungal infections (IFIs) in patients admitted to an intensive care unit (ICU) in Southern Italy and the in vitro antifungal susceptibility of isolates.
  
  
  METHODS
  A surveillance program was implemented in 18 ICUs. IFI cases were recorded using a standardized form.
  
  
  RESULTS
  A total of 105 episodes of IFIs occurred in 5,561 patients during the 18-month study. The main infections were caused by yeasts, more than filamentous fungi (overall incidence of 16.5 cases per 1,000 admissions and 2.3 cases per 1,000 admissions, respectively). The overall crude mortality rate was high (42.8 %), particularly for mold infections (61.5 %). All yeast infections were Candida bloodstream infections. Over half (59.8 %) were caused by Candida non-albicans, with C. parapsilosis being the most common (61.8 %). In the multivariate model, trauma admission diagnosis, prolonged stay in the ICU, and parenteral nutrition were independently associated with candidemia due to C. parapsilosis [odds ratio (OR) 3.5, (1.8-5.2); OR 3.5, (1.02-3.5); OR 3.6, (1.28-6.99), respectively]. Among mold infections, 12 patients suffered from invasive pulmonary aspergillosis, with Aspergillus fumigatus as the predominant pathogen (41.7 %). One case of brain scedosporiosis was identified. Overall, azoles and echinocandins resistance was uncommon.
  
  
  CONCLUSIONS
  Candida non-albicans species are the most frequent cause of candidemia in ICU patients. Mold infections are associated with a high mortality rate. This study confirms the importance of the epidemiological surveillance on IFIs in the ICU setting for documenting species distribution and antimicrobial susceptibility patterns to guide therapeutic choices.
authors: Department of Biomedical Science and Human Oncology-Hygiene Section, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124, Bari, Italy. mariateresa.montagna@uniba.it
authors: M T
authors: MT
authors: Montagna
authors: G
authors: G
authors: Caggiano
authors: G
authors: G
authors: Lovero
authors: O
authors: O
authors: De Giglio
authors: C
authors: C
authors: Coretti
authors: T
authors: T
authors: Cuna
authors: R
authors: R
authors: Iatta
authors: M
authors: M
authors: Giglio
authors: L
authors: L
authors: Dalfino
authors: F
authors: F
authors: Bruno
authors: F
authors: F
authors: Puntillo
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology; D001232:Aspergillus fumigatus / Q000187:drug effects / Q000302:isolation & purification*; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification*; D025141:Drug Resistance, Fungal; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007558:Italy / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000382:microbiology; D015995:Prevalence; D021681:Scedosporium / Q000187:drug effects / Q000302:isolation & purification*
chemical_list: D000935:Antifungal Agents