Intensive Care Medicine

, Volume 34, Issue 2, pp 292–299

Candidemia and candiduria in critically ill patients admitted to intensive care units in France: incidence, molecular diversity, management and outcome

Authors

    • Service de Bactériologie, Virologie, Parasitologie et HygièneHôpital Necker-Enfants Malades
    • Laboratoire de Parasitologie–Mycologie, Service de MicrobiologieHôpital Necker Enfants Malades
    • Assistance PubliqueHôpitaux de Paris
    • Unité Biologie et Pathogénicité Fongiques, INRA USC 2019Institut Pasteur
    • Faculté de MédecineUniversité René Descartes
  • Guillaume Kac
    • Assistance PubliqueHôpitaux de Paris
    • Unité d’Hygiène HospitalièreHôpital Européen Georges Pompidou
  • Philippe Aegerter
    • Assistance PubliqueHôpitaux de Paris
    • Informatique MédicaleHôpital Ambroise-Paré
  • Christophe d’Enfert
    • Unité Biologie et Pathogénicité Fongiques, INRA USC 2019Institut Pasteur
  • Jean-Yves Fagon
    • Assistance PubliqueHôpitaux de Paris
    • Faculté de MédecineUniversité René Descartes
    • Service de Réanimation MédicaleHôpital Européen Georges Pompidou
  • CandiRea Study Group
Original

DOI: 10.1007/s00134-007-0865-y

Cite this article as:
Bougnoux, M., Kac, G., Aegerter, P. et al. Intensive Care Med (2008) 34: 292. doi:10.1007/s00134-007-0865-y

Abstract

Objective

To determine the concomitant incidence, molecular diversity, management and outcome of nosocomial candidemia and candiduria in intensive care unit (ICU) patients in France.

Design

A 1-year prospective observational study in 24 adult ICUs.

Patients

Two hundred and sixty-two patients with nosocomial candidemia and/or candiduria.

Measurements and results

Blood and urine samples were collected when signs of sepsis were present. Antifungal susceptibility of Candida strains was determined; in addition, all blood and 72% of urine C. albicans isolates were analyzed by using multi-locus sequence type (MLST). The mean incidences of candidemia and candiduria were 6.7 and 27.4/1000 admissions, respectively. Eight percent of candiduric patients developed candidemia with the same species. The mean interval between ICU admission and candidemia was 19.0 ± 2.9 days, and 17.2 ± 1.1 days for candiduria. C. albicans and C. glabrata were isolated in 54.2% and 17% of blood and 66.5% and 21.6% of urine Candida-positive cultures, respectively. Fluconazole was the most frequently prescribed agent. In all candidemic patients, the prescribed curative antifungal agent was active in vitro against the responsible identified strain. Crude ICU mortality was 61.8% for candidemic and 31.3% for candiduric patients. Seventy-five percent of the patients were infected with a unique C. albicans strain; cross-transmission between seven patients was suggested in one hospital.

Conclusions

Candidemia is late-onset ICU-acquired infection associated with high mortality. No difference in susceptibility and genetic background were found between blood and urine strains of Candida species.

Keywords

CandidemiaCandiduriaNosocomial infectionsCritically ill patientsMolecular typing

Supplementary material

134_2007_865_MOESM1_ESM.doc (37 kb)
Electronic Supplementary Material (DOC 37K)
134_2007_865_MOESM2_ESM.ppt (78 kb)
Electronic Supplementary Material (PPT 80K)

Copyright information

© Springer-Verlag 2007