title: Invasive Candida infections in surgical patients in intensive care units: a prospective, multicentre survey initiated by the European Confederation of Medical Mycology (ECMM) (2006-2008).
abstract: A prospective, observational, multicentre study of invasive candidosis (IC) in surgical patients in intensive care units (ICUs) was conducted from 2006 to 2008 in 72 ICUs in 14 European countries. A total of 779 patients (62.5% males, median age 63 years) with IC were included. The median rate of candidaemia was 9 per 1000 admissions. In 10.8% the infection was already present at the time of admission to ICU. Candida albicans accounted for 54% of the isolates, followed by Candida parapsilosis 18.5%, Candida glabrata 13.8%, Candida tropicalis 6%, Candida krusei 2.5%, and other species 5.3%. Infections due to C. krusei (57.9%) and C. glabrata (43.6%) had the highest crude mortality rate. The most common preceding surgery was abdominal (51.5%), followed by thoracic (20%) and neurosurgery (8.2%). Candida glabrata was more often isolated after abdominal surgery in patients ≥60 years, and C. parapsilosis was more often isolated in neurosurgery and multiple trauma patients as well as children ≤1 year of age. The most common first-line treatment was fluconazole (60%), followed by caspofungin (18.7%), liposomal amphotericin B (13%), voriconazole (4.8%) and other drugs (3.5%). Mortality in surgical patients with IC in ICU was 38.8%. Multivariate analysis showed that factors independently associated with mortality were: patient age ≥60 years (hazard ratio (HR) 1.9, p 0.001), central venous catheter (HR 1.8, p 0.05), corticosteroids (HR 1.5, p 0.03), not receiving systemic antifungal treatment for IC (HR 2.8, p <0.0001), and not removing intravascular lines (HR 1.6, p 0.02).
authors: Department of Clinical Microbiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. Electronic address: lena.klingspor@ki.se.
authors: L
authors: L
authors: Klingspor
authors: Dipartimento Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy.
authors: A M
authors: AM
authors: Tortorano
authors: Department of Clinical Microbiology, La Fe University Hospital, Valencia, Spain.
authors: J
authors: J
authors: Peman
authors: Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.
authors: B
authors: B
authors: Willinger
authors: Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic.
authors: P
authors: P
authors: Hamal
authors: Département de Parasitologie-Mycologie, Inserm U995, Centre Hospitalier Régional Universitaire de Lille, Université Lille Nord de France, Lille, France.
authors: B
authors: B
authors: Sendid
authors: Mycology Research Laboratory, Department of Microbiology Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors: A
authors: A
authors: Velegraki
authors: Centre of Clinical Microbiology, University College London and Department of Medical Microbiology, Royal Free Hospital, London, UK.
authors: C
authors: C
authors: Kibbler
authors: Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital; Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors: J F
authors: JF
authors: Meis
authors: Department of Infectious Diseases, URSZ-Mycology, National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal.
authors: R
authors: R
authors: Sabino
authors: Department of Medicine, Charité Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany.
authors: M
authors: M
authors: Ruhnke
authors: Department of Medical Microbiology, Hacettepe University Medical School, Ankara, Turkey.
authors: S
authors: S
authors: Arikan-Akdagli
authors: Department of Medicine Päijät-Häme Central Hospital, Lahti, Finland.
authors: J
authors: J
authors: Salonen
authors: Department of Clinical Microbiology, University of Szeged, Szeged, Hungary.
authors: I
authors: I
authors: Dóczi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida; D058365:Candidiasis, Invasive / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Candida; candidaemia; epidemiology; invasive candidosis; surgical intensive care