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

Intensive Care Medicine volume 40, pages 839–845 (2014)Cite this article

An Erratum to this article was published on 03 July 2014

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.

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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.

Author information

Affiliations

  1. Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy

    Matteo Bassetti, Elda Righi & Maria Merelli

  2. Department of Health Sciences, IRCCS San Martino IST, University of Genoa, Genoa, Italy

    Filippo Ansaldi & Trucchi Cecilia

  3. Critical Care Department, Università Cattolica del Sacro Cuore, Rome, Italy

    Gennaro De Pascale & Massimo Antonelli

  4. Critical Care and Emergency Clinical Unit, Virgen del Rocio University Hospital, Seville, Spain

    Ana Diaz-Martin & Jose Garnacho-Montero

  5. Infectious Diseases Unit, University Hospital of Trieste, Trieste, Italy

    Roberto Luzzati & Chiara Rosin

  6. Critical Care Department, Vall d’Hebron University Hospital, CIBERES, Universitat autonoma de Barcelona, Barcelona, Spain

    Leonel Lagunes & Jordi Rello

  7. Institute of Infectious Diseases, Università Cattolica del Sacro Cuore, Rome, Italy

    Enrico Maria Trecarichi & Mario Tumbarello

  8. Institute of Microbiology, Università Cattolica del Sacro Cuore, Rome, Italy

    Maurizio Sanguinetti

  9. Institute of Public Health (Section of Hygiene), Università Cattolica del Sacro Cuore, Rome, Italy

    Brunella Posteraro

  10. Microbiology Unit, Santa Maria Misericordia University Hospital, Udine, Italy

    Assunta Sartor

  11. Critical Care Department, Santa Maria Misericordia University Hospital, Udine, Italy

    Giorgio Della Rocca

  12. Clinica Malattie Infettive, Azienda Ospedaliera Universitaria Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy

    Matteo Bassetti

Authors
  1. Matteo Bassetti
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  2. Elda Righi
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  3. Filippo Ansaldi
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  4. Maria Merelli
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  5. Trucchi Cecilia
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  6. Gennaro De Pascale
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  7. Ana Diaz-Martin
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  8. Roberto Luzzati
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  9. Chiara Rosin
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  10. Leonel Lagunes
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  11. Enrico Maria Trecarichi
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  12. Maurizio Sanguinetti
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  13. Brunella Posteraro
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  14. Jose Garnacho-Montero
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  15. Assunta Sartor
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  16. Jordi Rello
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  17. Giorgio Della Rocca
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  18. Massimo Antonelli
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  19. Mario Tumbarello
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Corresponding author

Correspondence to Matteo Bassetti.

Additional information

Take-home message: High mortality rates were confirmed in patients with Candida-induced septic shock. In this group, the administration of an adequate antifungal therapy along with adequate source control are key factors to improve clinical outcomes.

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Bassetti, M., Righi, E., Ansaldi, F. et al. A multicenter study of septic shock due to candidemia: outcomes and predictors of mortality. Intensive Care Med 40, 839–845 (2014). https://doi.org/10.1007/s00134-014-3310-z

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  • DOI: https://doi.org/10.1007/s00134-014-3310-z

Keywords

  • Candidemia
  • Septic shock
  • Fluconazole
  • Echinocandins
  • Catheter
  • Source control