Summary
Aim of this study was to evaluate whether risk factors which predict the development of candidemia may also predict death in ICU patients with candidemia. During an 8-year-period all ICU patients whose blood cultures yieldedCandida species (n=40) were retrospectively evaluated in a case-control fashion. The average incidence ofCandida bloodstream infections was 5.5 per 10,000 patient days, ranging from 2.4 in 1990 to 7.4 in 1994.C. albicans was the most common pathogen in candidemic patients, but the proportion of non-C. albicans strains showed an increasing trend during 1989–1993, with a major shift towards non-C. albicans species in 1994. The overall mortality of patients with candidemia was 58%. Mortality was highest in the group of patients with multi-organ dysfunction syndrome, especially among those in need of hemodialysis. Risk factors for the development of candidemia, such as age, malignancy, steroid use, i.v. catheterization, and the use of broad-spectrum antibiotics were not correlated with mortality in the ICU patients studied.
Article PDF
Similar content being viewed by others
References
Trilla, A. Epidemiology and nosocomial infections in adult intensive care units. Intens. Care Med. 20 (Suppl. 3) (1994) S1-S4.
Martin, M. A. Nosocomial infections in intensive care units: an overview of their epidemiology, outcome, and prevention. New Horiz. 1 (1993) 162–171.
Burnie, J. P., Odds, F. C., Lee, W., Webster, C., Williams, J. D. Outbreak of systemicCandida albicans infections in intensive care unit caused by cross infection. Br. Med. J. 290 (1985) 746–748.
Butler, K. M., Baker, C. J. Candida: an increasingly important pathogen in the nursery. Pediatr. Clin. N. Am. 35 (1988) 543–563.
Doebbeling, B. N., Stanley, G., Sheetz, C. T., Pfaller, M. A., Houston, A. K., Annis, L., Li, N., Wenzel, R. P. Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. N. Engl. J. Med. 327 (1992) 88–93.
Vaudry, W. L., Tierney, A. J., Wenman, W. M. Investigation of a cluster of systemicCandida albicans infections in a neonatal intensive care unit. J. Infect. Dis. 158 (1988) 1375–1379.
Banerjee, S. N., Emori, T. G., Culver, D. H., Gaynes, R. P., Jarvis, W. R., Horan, T., Edwards, J. E., Tolson, J., Henderson, T., Martone, W. J. Secular trends in nosocomial primary bloodstream infections in the United States, 1980–1989. National nosocomial infections surveillance system. Am. J. Med. 91 (1991) 86S-89S.
Broderick, A., Mori, M., Nettleman, M. D., Streed, S. A., Wenzel, R. P. Nosocomial infections: validation of surveillance and computer modeling to identify patients at risk. Am. J. Epidemiol. 131 (1990) 734–742.
Pittet, D., Wenzel, R. P. Nosocomial bloodstream infections. In:Wenzel, R. P. (ed.): Prevention and control of nosocomial infections. 2nd ed., Williams & Wilkins Co., Baltimore 1993, pp. 512–555.
Smith, R. L., Meixler, S. M., Simberkoff, M. S. Excess mortality in critically ill patients with nosocomial bloodstream infections. Chest 100 (1991) 164–167.
Sasse, K. C., Nauenberg, E., Long, A., Anton, B., Tucker, H. J., Hu, T. W. Long-term survival after intensive care unit admission with sepsis. Crit. Care Med. 23 (1995) 1040–1047.
Wey, S. B., Mori, M., Pfaller, M. A., Woolson, R. F., Wenzel, R. P. Risk factors for hospital-acquired candidemia. A matched case-control study. Arch. Intern. Med. 149 (1989) 2349–2353.
Pittet, D., Monod, M., Suter, P. M., Frenk, E., Auckenthaler, R. Candida colonization and subsequent infections in critically ill surgical patients. Ann. Surg. 220 (1994) 751–758.
Bross, J., Talbot, G. H., Maislin, G., Hurwitz, S., Strom, B. L. Risk factors for nosocomial candidemia: a case-control study in adults without leukemia. Am. J. Med. 87 (1989) 614–620.
LeGall, J. R., Lemeshow, S., Saulnier, F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270 (1993) 2957–2963.
Voss, A., Kluytmans, J. A. J. W., Koeleman, J. G. M., Spanjaard, L., Vandenbroucke-Grauls, C. M. J. E., Verbrugh, H. A., Vos, M. C., Weersink, A. J. L., Hoogkamp-Korstanje, J. A. A., Meis, J. F. G. M.: Occurrence ofCandida bloodstream infection in Dutch university hospitals between 1987 and 1995. Eur. J. Clin. Microbiol. Infect. Dis. (in press).
Powderly, W. G. Mucosal candidiasis caused by non-albicans species ofCandida in HIV-positive patients [letter]. AIDS 6 (1992) 604–605.
Wingard, J. R. Importance ofCandida species other thanC. albicans. as pathogens in oncology patients. Clin. Infect. Dis. 20 (1995) 115–125.
Kunova, A., Trupl, J., Spanik, S., Drgona, L., Sufliarsky, J., Lacka, J., Studena, V., Hlavacova, E., Studena, M., Kukuckova, E. Candida glabrata, Candida krusei, non-albicans Candida spp., and other fungal organisms in a sixty-bed national cancer center in 1989–1993: no association with the use of fluconazole. Chemotherapy 41 (1995) 39–44.
Wingard, J. R. Infections due to resistantCandida species in patients with cancer who are receiving chemotherapy. Clin. Infect. Dis. 19 Suppl. 1 (1994) S49-S53.
Verduyn Lunel, F. M., Voss, A., Neeleman, C., Meis, J. F. G. M. Candidemie metCandida krusei bij een niet-neutropene intensive care patient. Ned. Tijdschr. Med. Microbiol. 4 (1996) 28–29.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Voss, A., Meis, J.F.G.M., Lunel, F.M.V. et al. Candidemia in intensive care unit patients: Risk factors for mortality. Infection 25, 8–11 (1997). https://doi.org/10.1007/BF02113499
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02113499