title: Epidemiology of invasive candidiasis in a surgical intensive care unit: an observational study.
abstract: BACKGROUND
  Invasive candidiasis (IC) is a frequent and life-threatening infection in critically ill patients. The aim of this study was to evaluate the epidemiology of IC and the antifungal susceptibility of etiological agents in patients admitted to our surgical intensive care unit (SICU) in Spain.
  
  
  METHODS
  We designed a prospective, observational, single center, population-based study in a SICU. We included all consecutive adult patients (≥18 years old) who had documented IC, either on admission or during their stay, between January 2012 and December 2013.
  
  
  RESULTS
  There were a total of 22 episodes of IC in the 1149 patients admitted during the 24-month study. The overall IC incidence was 19.1 cases per 1000 admissions. Thirteen cases of IC (59.1%) were intra-abdominal candidiasis (IAC) and 9 (40.9%) were candidemias. All cases of IAC were patients with secondary peritonitis and severe sepsis or septic shock. The overall crude mortality rate was 13.6%; while, it was 33% in patients with candidemia. All patients with IAC survived, including one patient with concomitant candidemia. The most common species causing IC was Candida albicans (13; 59.1%) followed by Candida parapsilosis (5; 22.7%), and Candida glabrata (2; 9.1%). There was also one case each (4.5%) of Candida krusei and Candida tropicalis. Thus, the ratio of non-C. albicans (9) to C. albicans (13) was 1:1.4. There was resistance to fluconazole and itraconazole in 13.6% of cases. Resistance to other antifungals was uncommon.
  
  
  CONCLUSIONS
  Candida parapsilosis was the second most common species after C. albicans, indicating the high prevalence of non-C. albicans species in the SICU. Resistance to azoles, particularly fluconazole, should be considered when starting an empirical treatment. Although IAC is a very frequent form of IC in critically ill surgical patients, prompt antifungal therapy and adequate source control appears to lead to a good outcome. However, our results are closely related to our ICU and any generalization must be taken with caution. Therefore, further investigations are needed.
authors.affiliation: Surgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain. gerardo.aguilar@uv.es.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Aguilar
authors.affiliation: Surgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain. cardelna@gmail.com.
authors.forename: Carlos
authors.initials: C
authors.lastname: Delgado
authors.affiliation: Department of Microbiology, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain. isabelcorrales21@hotmail.com.
authors.forename: Isabel
authors.initials: I
authors.lastname: Corrales
authors.affiliation: Surgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain. anaizpa@gmail.com.
authors.forename: Ana
authors.initials: A
authors.lastname: Izquierdo
authors.affiliation: Surgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain. esgrafe@hotmail.com.
authors.forename: Estefanía
authors.initials: E
authors.lastname: Gracia
authors.affiliation: Surgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain. taniaras@hotmail.com.
authors.forename: Tania
authors.initials: T
authors.lastname: Moreno
authors.affiliation: Surgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain. Esthi24@hotmail.com.
authors.forename: Esther
authors.initials: E
authors.lastname: Romero
authors.affiliation: Surgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain. cafeoranestesia@gmail.com.
authors.forename: Carlos
authors.initials: C
authors.lastname: Ferrando
authors.affiliation: Surgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain. joseacarbonell19@hotmail.com.
authors.forename: José A
authors.initials: JA
authors.lastname: Carbonell
authors.affiliation: Department of Microbiology, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain. rafael.borras@uv.es.|School of Medicine, University of Valencia, Avenida Blasco Ibáñez 15, 46010, Valencia, Spain. rafael.borras@uv.es.
authors.forename: Rafael
authors.initials: R
authors.lastname: Borrás
authors.affiliation: Department of Microbiology, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain. david.navarro@uv.es.|School of Medicine, University of Valencia, Avenida Blasco Ibáñez 15, 46010, Valencia, Spain. david.navarro@uv.es.
authors.forename: David
authors.initials: D
authors.lastname: Navarro
authors.affiliation: Surgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain. fjbelda@uv.es.|School of Medicine, University of Valencia, Avenida Blasco Ibáñez 15, 46010, Valencia, Spain. fjbelda@uv.es.
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Belda
mesh_terms: D000005:Abdomen / Q000382:microbiology / Q000473:pathology; D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification; D058365:Candidiasis, Invasive / Q000453:epidemiology* / Q000382:microbiology; D025141:Drug Resistance, Fungal / Q000187:drug effects; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013030:Spain / Q000453:epidemiology; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D013530:Surgical Wound Infection / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents