title: Prognostic factors and historical trends in the epidemiology of candidemia in critically ill patients: an analysis of five multicenter studies sequentially conducted over a 9-year period.
abstract: OBJECTIVE
  To describe temporal trends in the epidemiology, clinical management and outcome of candidemia in intensive care unit (ICU) patients.
  
  
  METHODS
  This study was a retrospective analysis of 1,392 episodes of candidemia in 647 adult ICU patients from 22 Brazilian hospitals. The characteristics of candidemia in these ICU patients were compared in two periods (2003-2007, period 1; 2008-2012, period 2), and the predictors of 30-day mortality were assessed.
  
  
  RESULTS
  The proportion of patients who developed candidemia while in the ICU increased from 44 % in period 1 to 50.9 % in period 2 (p = 0.01). Prior exposure to fluconazole before candidemia (22.3 vs. 11.6 %, p < 0.001) and fungemia due to Candida glabrata (13.1 vs. 7.8 %, p = 0.03) were more frequent in period 2, as was the proportion of patients receiving an echinocandin as primary therapy (18.0 vs. 5.9 %, p < 0.001). The 30-day mortality rate decreased from 76.4 % in period 1 to 60.8 % in period 2 (p < 0.001). Predictors of 30-day mortality by multivariate analysis were older age, period 1, treatment with corticosteroids and higher APACHE II score, while treatment with an echinocandin were associated with a higher probability of survival.
  
  
  CONCLUSIONS
  We found a clear change in the epidemiology and clinical management of candidemia in ICU patients over the 9-year period of the study. The use of echinocandins as primary therapy for candidemia appears to be associated with better outcomes.
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil, arnaldolcolombo@gmail.com.
authors.forename: Arnaldo L
authors.initials: AL
authors.lastname: Colombo
authors.forename: Thais
authors.initials: T
authors.lastname: Guimarães
authors.forename: Teresa
authors.initials: T
authors.lastname: Sukienik
authors.forename: Alessandro C
authors.initials: AC
authors.lastname: Pasqualotto
authors.forename: Ricardo
authors.initials: R
authors.lastname: Andreotti
authors.forename: Flavio
authors.initials: F
authors.lastname: Queiroz-Telles
authors.forename: Simone A
authors.initials: SA
authors.lastname: Nouér
authors.forename: Marcio
authors.initials: M
authors.lastname: Nucci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D016638:Critical Illness; D003840:Deoxycholic Acid / Q000627:therapeutic use*; D054714:Echinocandins / Q000627:therapeutic use*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D002756:Cholagogues and Choleretics; D054714:Echinocandins; D003840:Deoxycholic Acid
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