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Intensive Care Medicine

, Volume 40, Issue 6, pp 839–845 | Cite as

A multicenter study of septic shock due to candidemia: outcomes and predictors of mortality

  • Matteo Bassetti
  • Elda Righi
  • Filippo Ansaldi
  • Maria Merelli
  • Trucchi Cecilia
  • Gennaro De Pascale
  • Ana Diaz-Martin
  • Roberto Luzzati
  • Chiara Rosin
  • Leonel Lagunes
  • Enrico Maria Trecarichi
  • Maurizio Sanguinetti
  • Brunella Posteraro
  • Jose Garnacho-Montero
  • Assunta Sartor
  • Jordi Rello
  • Giorgio Della Rocca
  • Massimo Antonelli
  • Mario Tumbarello
Original

Abstract

Purpose

Candida is the most common cause of severe yeast infections worldwide, especially in critically ill patients. In this setting, septic shock attributable to Candida is characterized by high mortality rates. The aim of this multicenter study was to investigate the determinants of outcome in critically ill patients with septic shock due to candidemia.

Methods

This was a retrospective study in which patients with septic shock attributable to Candida who were treated during the 3-year study period at one or more of the five participating teaching hospitals in Italy and Spain were eligible for enrolment. Patient characteristics, infection-related variables, and therapy-related features were reviewed. Multiple logistic regression analysis was performed to identify the risk factors significantly associated with 30-day mortality.

Results

A total of 216 patients (mean age 63.4 ± 18.5 years; 58.3 % males) were included in the study. Of these, 163 (75 %) were admitted to the intensive care unit. Overall 30-day mortality was 54 %. Significantly higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, dysfunctional organs, and inadequate antifungal therapy were compared in nonsurvivors and survivors. No differences in survivors versus nonsurvivors were found in terms of the time from positive blood culture to initiation of adequate antifungal therapy. Multivariate logistic regression identified inadequate source control, inadequate antifungal therapy, and 1-point increments in the APACHE II score as independent variables associated with a higher 30-day mortality rate.

Keywords

Candidemia Septic shock Fluconazole Echinocandins Catheter Source control 

Notes

Acknowledgments

This research was conducted in collaboration with the Critically Ill Patients Study Group (CIPSG) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID).

Conflicts of interest

MB serves on scientific advisory boards for Pfizer Inc, Merck Serono, and Astellas Pharma Inc. and has received funding for travel or speaker honoraria from Pfizer Inc., Merck Serono, Gilead Sciences, Teva Inc and Astellas Pharma Inc. The other authors declare no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2014

Authors and Affiliations

  • Matteo Bassetti
    • 1
    • 12
  • Elda Righi
    • 1
  • Filippo Ansaldi
    • 2
  • Maria Merelli
    • 1
  • Trucchi Cecilia
    • 2
  • Gennaro De Pascale
    • 3
  • Ana Diaz-Martin
    • 4
  • Roberto Luzzati
    • 5
  • Chiara Rosin
    • 5
  • Leonel Lagunes
    • 6
  • Enrico Maria Trecarichi
    • 7
  • Maurizio Sanguinetti
    • 8
  • Brunella Posteraro
    • 9
  • Jose Garnacho-Montero
    • 4
  • Assunta Sartor
    • 10
  • Jordi Rello
    • 6
  • Giorgio Della Rocca
    • 11
  • Massimo Antonelli
    • 3
  • Mario Tumbarello
    • 7
  1. 1.Infectious Diseases DivisionSanta Maria Misericordia University HospitalUdineItaly
  2. 2.Department of Health Sciences, IRCCS San Martino ISTUniversity of GenoaGenoaItaly
  3. 3.Critical Care DepartmentUniversità Cattolica del Sacro CuoreRomeItaly
  4. 4.Critical Care and Emergency Clinical UnitVirgen del Rocio University HospitalSevilleSpain
  5. 5.Infectious Diseases UnitUniversity Hospital of TriesteTriesteItaly
  6. 6.Critical Care Department, Vall d’Hebron University Hospital, CIBERESUniversitat autonoma de BarcelonaBarcelonaSpain
  7. 7.Institute of Infectious DiseasesUniversità Cattolica del Sacro CuoreRomeItaly
  8. 8.Institute of MicrobiologyUniversità Cattolica del Sacro CuoreRomeItaly
  9. 9.Institute of Public Health (Section of Hygiene)Università Cattolica del Sacro CuoreRomeItaly
  10. 10.Microbiology UnitSanta Maria Misericordia University HospitalUdineItaly
  11. 11.Critical Care DepartmentSanta Maria Misericordia University HospitalUdineItaly
  12. 12.Clinica Malattie InfettiveAzienda Ospedaliera Universitaria Santa Maria della MisericordiaUdineItaly

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