title: A multicenter study of septic shock due to candidemia: outcomes and predictors of mortality.
abstract: OBJECTIVE
  Candida is the most common cause of severe yeast infections worldwide, especially in critically ill patients. In this setting, septic shock attributable to Candida is characterized by high mortality rates. The aim of this multicenter study was to investigate the determinants of outcome in critically ill patients with septic shock due to candidemia.
  
  
  METHODS
  This was a retrospective study in which patients with septic shock attributable to Candida who were treated during the 3-year study period at one or more of the five participating teaching hospitals in Italy and Spain were eligible for enrolment. Patient characteristics, infection-related variables, and therapy-related features were reviewed. Multiple logistic regression analysis was performed to identify the risk factors significantly associated with 30-day mortality.
  
  
  RESULTS
  A total of 216 patients (mean age 63.4 ± 18.5 years; 58.3 % males) were included in the study. Of these, 163 (75 %) were admitted to the intensive care unit. Overall 30-day mortality was 54 %. Significantly higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, dysfunctional organs, and inadequate antifungal therapy were compared in nonsurvivors and survivors. No differences in survivors versus nonsurvivors were found in terms of the time from positive blood culture to initiation of adequate antifungal therapy. Multivariate logistic regression identified inadequate source control, inadequate antifungal therapy, and 1-point increments in the APACHE II score as independent variables associated with a higher 30-day mortality rate.
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy, mattba@tin.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bassetti
authors.forename: Elda
authors.initials: E
authors.lastname: Righi
authors.forename: Filippo
authors.initials: F
authors.lastname: Ansaldi
authors.forename: Maria
authors.initials: M
authors.lastname: Merelli
authors.forename: Cecilia
authors.initials: C
authors.lastname: Trucchi
authors.forename: Trucchi
authors.initials: T
authors.lastname: Cecilia
authors.forename: Gennaro
authors.initials: G
authors.lastname: De Pascale
authors.forename: Ana
authors.initials: A
authors.lastname: Diaz-Martin
authors.forename: Roberto
authors.initials: R
authors.lastname: Luzzati
authors.forename: Chiara
authors.initials: C
authors.lastname: Rosin
authors.forename: Leonel
authors.initials: L
authors.lastname: Lagunes
authors.forename: Enrico Maria
authors.initials: EM
authors.lastname: Trecarichi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Sanguinetti
authors.forename: Brunella
authors.initials: B
authors.lastname: Posteraro
authors.forename: Jose
authors.initials: J
authors.lastname: Garnacho-Montero
authors.forename: Assunta
authors.initials: A
authors.lastname: Sartor
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.forename: Giorgio Della
authors.initials: GD
authors.lastname: Rocca
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
authors.forename: Mario
authors.initials: M
authors.lastname: Tumbarello
mesh_terms: D000368:Aged; D058387:Candidemia / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality*; D015996:Survival Rate; D016896:Treatment Outcome