Risk Factors for Candida Infection in the Intensive Care Unit

North American Perspective
  • Rhonda V. Fleming
  • Thomas J. Walsh
Part of the Perspectives on Critical Care Infectious Diseases book series (CCID, volume 6)


Recent improvements in the delivery of health care in the fields of oncology, surgery, transplantation, and critical care have made possible the support of critically ill and severely immunosuppressed patients for prolonged periods of time. As a result, the opportunity for the acquisition of nosocomial invasive infections has increased. Data from the National Nosocomial Infections Surveillance (NNIS) system revealed that the rate of fungal infections increased from 2.0 to 3.8 per 100 hospital discharges between 1980 and 1990 (1). The rate of bloodstream infection (BSI) due toCandidaspecies has increased significantly: nosocomial infections due toCandidaspecies currently rank fourth (2). The associated crude mortality is high despite optimal treatment with amphotericin B and the new triazoles. In a previous cohort study of nosocomial Candida fungemia, the crude and attributable mortality for cases and controls was reported to be 57% and 19% respectively. The attributable mortality rate for the infection was 38% (3). The incidence and relative prevalence of Candida infections in patients requiring intensive care has increased dramatically. Recent studies indicate that 23% of Candida BSIs occurred in patients hospitalized in an intensive care unit (ICU) (4). Numerous outbreaks or clusters of infections due toCandidaspecies in ICUs have been described (5-8) When compared to patients hospitalized in general wards, patients in the ICU are at increased risk for acquiring nosocomial infections including pneumonia, bloodstream and urinary tract infections. This trend is obviously due to several interventions that include the high rate of invasive procedures. Such procedures in the ICU include insertion of central venous catheters peripheral arterial access,endotracheal intubation with positive endexpiratory pressure and bladder catheterization.


Neonatal Intensive Care Unit Candida Species Invasive Candidiasis Candida Infection National Nosocomial Infection Surveillance 
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Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • Rhonda V. Fleming
    • 1
  • Thomas J. Walsh
    • 2
  1. 1.Yale University School of MedicineNew HavenConnecticut
  2. 2.National Institutes of HealthBethesda, MarylandUSA

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