title: Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002-2010).
abstract: OBJECTIVE
  To analyze trends in incidence and mortality of candidemia in intensive care units (ICUs) vs. non-ICU hospitalized patients and to determine risk factors for infection by specific species and for death.
  
  
  METHODS
  Active hospital-based surveillance program of incident episodes of candidemia due to common species in 24 tertiary care hospitals in the Paris area, France between October 2002 and September 2010.
  
  
  RESULTS
  Among 2,507 adult cases included, 2,571 Candida isolates were collected and species were C. albicans (56 %), C. glabrata (18.6 %), C. parapsilosis (11.5 %), C. tropicalis (9.3 %), C. krusei (2.9 %), and C. kefyr (1.8 %). Candidemia occurred in ICU in 1,206 patients (48.1 %). When comparing ICU vs. non-ICU patients, the former had significantly more frequent surgery during the past 30 days, were more often preexposed to fluconazole and treated with echinocandin, and were less frequently infected with C. parapsilosis. Risk factors and age remained unchanged during the study period. A significant increased incidence in the overall population and ICU was found. The odds of being infected with a given species in ICU was influenced by risk factors and preexposure to fluconazole and caspofungin. Echinocandins initial therapy increased over time in ICU (4.6 % first year of study, to 48.5 % last year of study, p < 0.0001). ICU patients had a higher day-30 death rate than non-ICU patients (odds ratio [OR] 2.12; 95 % confidence interval [CI] 1.66-2.72; p < 0.0001). The day-30 and early (<day 8) death rates increased over time in ICU (from 41.5 % the first to 56.9 % the last year of study (p = 0.001) and 28.7-38.8 % (p = 0.0292), respectively). Independent risk factors for day-30 death in ICU were age, arterial catheter, Candida species, preexposure to caspofungin, and lack of antifungal therapy at the time of blood cultures results (p < 0.05).
  
  
  CONCLUSIONS
  The availability of new antifungals and the publication of numerous guidelines did not prevent an increase of candidemia and death in ICU patients in the Paris area.
authors.affiliation: Unité de Mycologie Moléculaire, Centre National de Référence Mycologie et Antifongiques, Institut Pasteur, Paris, France, olivier.lortholary@wanadoo.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.forename: Charlotte
authors.initials: C
authors.lastname: Renaudat
authors.forename: Karine
authors.initials: K
authors.lastname: Sitbon
authors.forename: Yoann
authors.initials: Y
authors.lastname: Madec
authors.forename: Lise
authors.initials: L
authors.lastname: Denoeud-Ndam
authors.forename: Michel
authors.initials: M
authors.lastname: Wolff
authors.forename: Arnaud
authors.initials: A
authors.lastname: Fontanet
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bretagne
authors.forename: Françoise
authors.initials: F
authors.lastname: Dromer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010297:Paris / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000935:Antifungal Agents
references.citation: Clin Infect Dis. 2008 Apr 15;46(8):1206-13
references.pmid: 18444857
references.citation: Clin Microbiol Rev. 2007 Jan;20(1):133-63
references.pmid: 17223626
references.citation: Clin Infect Dis. 2012 Apr;54(8):1110-22
references.pmid: 22412055
references.citation: Antimicrob Agents Chemother. 2011 Feb;55(2):532-8
references.pmid: 21078946
references.citation: Crit Care Med. 2013 May;41(5):1167-74
references.pmid: 23442987
references.citation: Antimicrob Agents Chemother. 2011 Nov;55(11):5358-61
references.pmid: 21859944
references.citation: Clin Infect Dis. 2012 Nov 15;55(10):1352-61
references.pmid: 22893576
references.citation: Clin Infect Dis. 2012 Jun;54(12):1739-46
references.pmid: 22423135
references.citation: J Clin Microbiol. 2011 May;49(5):1866-71
references.pmid: 21411591
references.citation: Clin Infect Dis. 2009 Jun 15;48(12):1695-703
references.pmid: 19441981
references.citation: Crit Care Med. 2014 Mar;42(3):625-31
references.pmid: 24201173
references.citation: J Clin Microbiol. 2006 Aug;44(8):2816-23
references.pmid: 16891497
references.citation: Diagn Microbiol Infect Dis. 2012 Dec;74(4):323-31
references.pmid: 23102556
references.citation: Clin Infect Dis. 2013 Jun;56(12):1724-32
references.pmid: 23487382
references.citation: Clin Infect Dis. 2009 Mar 1;48(5):503-35
references.pmid: 19191635
references.citation: J Antimicrob Chemother. 2011 Dec;66(12):2880-6
references.pmid: 21980066
references.citation: Clin Infect Dis. 2013 Nov;57(9):1237-45
references.pmid: 23899684
references.citation: Clin Microbiol Infect. 2011 Oct;17(10):1538-45
references.pmid: 20718804
references.citation: Clin Microbiol Infect. 2013 Aug;19(8):E343-53
references.pmid: 23607326
references.citation: Clin Infect Dis. 2006 Jul 1;43(1):25-31
references.pmid: 16758414
references.citation: Clin Microbiol Infect. 2010 Nov;16(11):1676-82
references.pmid: 20219079
references.citation: Clin Infect Dis. 2004 Feb 1;38(3):311-20
references.pmid: 14727199
references.citation: Intensive Care Med. 2014 Jun;40(6):839-45
references.pmid: 24807083
references.citation: PLoS One. 2011;6(9):e24198
references.pmid: 21935385
references.citation: Emerg Infect Dis. 2012 Jan;18(1):86-90
references.pmid: 22257484
references.citation: J Clin Microbiol. 2005 Apr;43(4):1829-35
references.pmid: 15815004
references.citation: Crit Care Med. 2008 Jul;36(7):1993-8
references.pmid: 18552702
references.citation: Clin Infect Dis. 2005 Nov 1;41(9):1232-9
references.pmid: 16206095
references.citation: Antimicrob Agents Chemother. 2007 Jan;51(1):35-9
references.pmid: 17101684
references.citation: J Antimicrob Chemother. 2010 May;65(5):1042-51
references.pmid: 20202987
references.citation: J Clin Microbiol. 2011 Sep;49(9):3300-8
references.pmid: 21715585
references.citation: J Clin Microbiol. 2013 Mar;51(3):841-8
references.pmid: 23269738
references.citation: Anaesth Intensive Care. 2010 Jul;38(4):703-9
references.pmid: 20715735
references.citation: Chest. 2011 Nov;140(5):1223-1231
references.pmid: 21852297
references.citation: Med Mycol. 2013 Apr;51(3):225-30
references.pmid: 22920712
references.citation: Clin Infect Dis. 2004 Aug 1;39(3):309-17
references.pmid: 15306996
references.citation: BMC Infect Dis. 2010 Jun 03;10:150
references.pmid: 20525301
references.citation: Cancer. 2009 Oct 15;115(20):4745-52
references.pmid: 19634156
references.citation: Intensive Care Med. 2014 Jun;40(6):808-19
references.pmid: 24718642
references.citation: Crit Care Med. 2008 Nov;36(11):2967-72
references.pmid: 18824910
references.citation: J Clin Microbiol. 2012 Nov;50(11):3435-42
references.pmid: 22875889
references.citation: Clin Microbiol Infect. 2012 Dec;18 Suppl 7:19-37
references.pmid: 23137135