title: Candidemia in intensive care unit: a nationwide prospective observational survey (GISIA-3 study) and review of the European literature from 2000 through 2013.
abstract: BACKGROUND
  Candida bloodstream infections (BSI) represent an important problem in Intensive Care Units (ICUs). The epidemiology of candidemia is changing with an increase in the proportion of Candida (C.) non-albicans.
  
  
  OBJECTIVE
  An Italian 2-year observational survey on ICU was conducted to evaluate the species distribution and possible differences between BSI caused by C. albicans and C. non-albicans. For comparative purposes, we performed a European literature-based review to evaluate distribution and frequency of Candida spp. causing ICU candidemia, during the period 2000-2013.
  
  
  METHODS
  This laboratory-based survey involved 15 microbiology centers (GISIA-3 study). All candidemia episodes in adult patients were considered. Data were prospectively collected from 2007 to 2008. PubMed was searched for peer-reviewed articles.
  
  
  RESULTS
  In total, 462 candidemia episodes were collected. C. albicans accounted for 49.4% of the isolates, followed by C. parapsilosis (26.2%) and C. glabrata (10.4%). Mortality was higher in patients with C. non-albicans than C. albicans (47.3% vs. 32.4 %, p > 0.05). Among risk factors, parenteral nutrition was more common (p = 0.02) in non-albicans candidemia, while surgery was more frequent (p = 0.02) in C. albicans candidemia. Twenty-four relevant articles were identified. C. albicans was the predominant species in almost all studies (range 37.9% -76.3%). C. glabrata was commonly isolated in the German-speaking countries, France, UK and North Europe; C. parapsilosis in Turkey, Greece and Spain.
  
  
  CONCLUSIONS
  Although C. non-albicans BSI is increasing, our study shows that C. albicans is still the predominant species in ICU candidemia. There are differences in the epidemiology of Candida BSI among European countries, with a prevalence of C. glabrata and C. parapsilosis in Northern and Southern countries, respectively.
authors.affiliation: Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari Aldo Moro, Bari, Italy. mariateresa.montagna@uniba.it.
authors.forename: M T
authors.initials: MT
authors.lastname: Montagna
authors.forename: G
authors.initials: G
authors.lastname: Lovero
authors.forename: E
authors.initials: E
authors.lastname: Borghi
authors.forename: G
authors.initials: G
authors.lastname: Amato
authors.forename: S
authors.initials: S
authors.lastname: Andreoni
authors.forename: L
authors.initials: L
authors.lastname: Campion
authors.forename: G
authors.initials: G
authors.lastname: Lo Cascio
authors.forename: G
authors.initials: G
authors.lastname: Lombardi
authors.forename: F
authors.initials: F
authors.lastname: Luzzaro
authors.forename: E
authors.initials: E
authors.lastname: Manso
authors.forename: M
authors.initials: M
authors.lastname: Mussap
authors.forename: P
authors.initials: P
authors.lastname: Pecile
authors.forename: S
authors.initials: S
authors.lastname: Perin
authors.forename: E
authors.initials: E
authors.lastname: Tangorra
authors.forename: M
authors.initials: M
authors.lastname: Tronci
authors.forename: R
authors.initials: R
authors.lastname: Iatta
authors.forename: G
authors.initials: G
authors.lastname: Morace
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D058387:Candidemia / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D005602:France / Q000453:epidemiology; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units / Q000639:trends*; D008875:Middle Aged; D064887:Observational Studies as Topic / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014421:Turkey / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents