title: ICU-acquired candidaemia in France: Epidemiology and temporal trends, 2004-2013 - A study from the REA-RAISIN network.
abstract: Candidaemia is a life-threatening infectious disease, associated with septic shock, multiple organ failure, and a high mortality rate. In France, reported data on the incidence of ICU-acquired candidaemia and the causative Candida species are scarce. The objective of this study was to determine temporal trends in epidemiology and risk factors of intensive care unit-acquired candidaemia (ICU-Cand) and ICU mortality among a very large population of ICU patients.
  
  
  
  Demographics, patient risk factors, invasive device exposure and nosocomial infection in ICU patient were collected from 2004 to 2013 in a national network of 213 ICUs: REA-RAISIN. Incidence and risk factors for candidaemia and ICU mortality were assessed.
  
  
  
  Out of 246,459 ICU patients, 851 developed an ICU-cand, representing 0.3 per 1000 patients-days. The incidence rose sharply over time. Candida albicans was the main species. The overall and ICU mortality was 52.4% in ICU-cand patients. The main risk factors of ICU-cand were length of stay, severity of illness and antimicrobial therapy at ICU admission, immune status and use of invasive procedure. ICU-cand was an independent risk factor of mortality (OR: 1.53; 95%CI [1.40-1.70]); in a sub-group analysis, independent effects on mortality were observed with C. albicans (OR: 1.45 [1.23-1.71]), Candida tropicalis (OR: 2.11 [1.31-3.39]) and "other" Candida species (OR: 1.64 [1.09-2.45]).
  
  
  
  ICU candidaemia ranked sixth among bloodstream infections, and its average annual incidence was 0.3 per 1000 patients days. Despite of new therapy and international recommendation, the incidence rose sharply during the study period, and ICU mortality remained high.
authors.affiliation: Centre Hospitalier Intercommunal Aix-Pertuis, Aix en Provence, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Baldesi
authors.affiliation: UMR 1137 - IAME Team 5 - DeSCID: Decision SCiences in Infectious Diseases, Control and Care INSERM Université Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Bailly
authors.affiliation: UMR 1137 - IAME Team 5 - DeSCID: Decision SCiences in Infectious Diseases, Control and Care INSERM Université Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ruckly
authors.affiliation: Unité de recherche clinique Soins critiques, Lyon, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Lepape
authors.affiliation: CCLIN Paris-Nord - APHP, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: L'Heriteau
authors.affiliation: CCLIN Ouest - CHU Rennes, Rennes, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Aupee
authors.affiliation: CCLIN Est - CHU Nancy, Nancy, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Boussat
authors.affiliation: CCLIN Sud-Ouest - CHU Bordeaux, Bordeaux, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Bervas
authors.affiliation: CCLIN Sud-Est - HCL, Lyon, France.
authors.forename: Anais
authors.initials: A
authors.lastname: Machut
authors.affiliation: Unité Infections associées aux soins et Résistance aux Antibiotiques, Direction Maladies Infectieuses - Santé publique France - Saint Maurice, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Berger-Carbonne
authors.affiliation: CCLIN Sud-Est - HCL - CNRS UMR 5558 Université de Lyon 1, Lyon, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Savey
authors.affiliation: UMR 1137 - IAME Team 5 - DeSCID: Decision SCiences in Infectious Diseases, Control and Care INSERM Université Paris Diderot, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP - Medical and Infectious Diseases ICU, Université Paris Diderot/Hôpital Bichat, Paris, France. Electronic address: Jean-francois.timsit@bch.aphp.fr.
authors.forename: Jean François
authors.initials: JF
authors.lastname: Timsit
authors.affiliation: REA-RAISIN, Lyon, France.
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000235:genetics / Q000302:isolation & purification; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D000091402:Prohibitins; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents; C000717331:PHB2 protein, human; D000091402:Prohibitins
keywords: Candidaemia; Epidemiology; ICU