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Candiduria in critically ill patients admitted to intensive care medical units

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Abstract

Background

The purpose of this study was to determine the incidence of candiduria in critically ill patients admitted to intensive care medical units (ICUs), to identify risk factors for candiduria and to assess the frequency distribution of different Candida spp.

Subjects and methods

This was a prospective cohort observational and multicenter study. A total of 1,765 patients older than 18 years of age who were admitted for at least 7 days to 73 medical-surgical ICUs of 70 Spanish hospitals were included in the study. Urine cultures were performed once a week.

Results

In 389 patients (22%), Candida spp. in one or more urine samples were isolated. In the multivariate analysis, independent risk factors for candiduria included: age >65 years, female sex, length of hospital stay before ICU admission, diabetes mellitus, total parenteral nutrition, mechanical ventilation and previous use of antimicrobials. Candida albicans was recovered in 266 cases (68.4%), followed by C. glabrata (32 cases, 8.2%) and C. tropicalis (14 cases, 36%). Previous use of antifungal agents was the only risk factor for the selection of Candida non-albicans candiduria (OR 2.64, 95% CI 1.35–5.14, P =0.004). In-hospital mortality was 48.8% in patients with candiduria compared to 36.6% in those without candiduria ( P <0.001). Significant differences were also found for ICU mortality (38.% vs. 28.1%, P <0.001).

Conclusions

Twenty-two percent of critically ill patients admitted for more than 7 days in the ICU developed candiduria. C. albicans was the most frequent causative pathogen. Previous use of antifungals was the only risk factor for the selection of Candida non-albicans.

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Acknowledgements

We thank Marta Pulido, MD, for editing the manuscript and editorial assistance.

Author information

Authors and Affiliations

  1. Department of Intensive Care Medicine, Hospital Universitari del Mar, Paseo Marítimo 25-29, 08003 , Barcelona, Spain

    Francisco Álvarez-Lerma & Juan Nolla-Salas

  2. Department of Intensive Care Medicine, Hospital de Valme, Sevilla, Spain

    Cristobal León

  3. Department of Intensive Care Medicine, Hospital Vall d'Hebrón, Barcelona, Spain

    Mercedes Palomar

  4. Department of Intensive Care Medicine, Hospital de Son Dureta, Palma de Mallorca, Spain

    Ricard Jordá

  5. Department of Intensive Care Medicine, Hospital de la Princesa, Madrid, Spain

    Nieves Carrasco

  6. Department of Intensive Care Medicine, Hospital Clínico, Valladolid, Spain

    Felipe Bobillo

Authors
  1. Francisco Álvarez-Lerma
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  2. Juan Nolla-Salas
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  3. Cristobal León
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  4. Mercedes Palomar
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  5. Ricard Jordá
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  6. Nieves Carrasco
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  7. Felipe Bobillo
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Corresponding author

Correspondence to Francisco Álvarez-Lerma.

Additional information

This study was carried out with the EPCAN Study Group: J. Nolla, F. Álvarez-Lerma, M Salvadó (Hospital del Mar, Barcelona); N. Carrasco, A. Bueno (Hospital de la Princesa, Madrid); F. Bobillo, P. Ucio (Hospital Clínico, Valladolid); M.A. León, M. Nolla, R.A. Díaz (Hospital General de Cataluña, Barcelona); J.R. Iruretagoyena, K. Esnaola, I. Andetxaga (Hospital de Cruces, Bilbao); A. Blanco, F. Taboada, R. Fernández (Hospital Nuestra Señora de Covadonga, Oviedo); M. Nieto, R. Diego, F. Ortuño (Hospital Clínico San Carlos, Madrid); P. Marcos, E. Mesalles (Hospital Germans Trias i Pujol, Badalona, Barcelona); A. Martínez, M. Fernández, F. Jaime (Hospital Virgen de la Arrixaca, Murcia); H. Sancho, N. Izquierdo (Hospital Reina Sofía, Córdoba); M. Ulibarrena, F. Labayen (Hospital Santiago Apóstol, Vitoria); F. Barcenilla, M.J. Gil, B. Balsera (Hospital Arnau de Villanova, Lleida); R. Jordá, M. Jurado, J. Pérez (Hospital Son Dureta, Palma de Mallorca); E. Zavala, A. Alcón, N. Fabregues (Hospital Clínic i Provincial, Barcelona); M.V. de la Torre, M.A. Estecha, A. Soler (Hospital Virgen de la Victoria, Málaga); M. Bodí, D. Castander (Hospital Joan XXIII, Tarragona); A. Mendía, J. Artaetxebarría, C. Reviejo (Hospital Nuestra Señora de Aránzazu, San Sebastián); M. Sánchez, A. Casamitjana, C. Pérez (Hospital Insular, Las Palmas de Gran Canaria); M.J. López, E. Robles (Hospital General de Segovia, Segovia); Y. Insausti, J.A. Tihistsa (Hospital de Navarra, Pamplona); C. García, J.M. Rubio (Hospital 12 de Octubre, Madrid); R. Oltra, O. Rodríguez (Hospital Clínico Universitario, Valencia); P. Olaechea, R. de Celís (Hospital de Galdakao, Bizkaia); J.M. Soto, J. Pomares (Hospital San Cecilio, Granada); J. Luna, G. Masdeu (Hospital Virgen de la Cinta, Tarragona); R. Sierra, A. Gordillo (Hospital Puerta del Mar, Cádiz); R. Rodríguez, J. Fajardo (Hospital Virgen de la Macarena, Sevilla); M.A. Herranz, J.I. Gómez (Hospital Río Hortega, Valladolid); R.M. García, M.J. Espina (Hospital de Cabueñes, Gijón); J. Garnacho, C. Ortiz (Hospital Virgen del Rocío, Sevilla); M. Palomar, J. Montero J (Hospital Vall d'Hebron, Barcelona); C. Cisneros, A. Sandiumenje (UCI de Traumatología, Hospital 12 de Octubre, Madrid); M. Sánchez, M. Álvarez (Hospital Príncipe de Asturias, Madrid); V. López, R. Julve (Hospital de Sagunto, Valencia); J. Solé, M. Valerón (Hospital Nuestra Señora del Pino, Las Palmas de Gran Canaria); M.A. Blasco, S. Borrás (Hospital Dr. Peset, Valencia); E. Maraví, J.M. Urtasun (Hospital Virgen del Camino, Pamplona); C. Sánchez-Díaz (Hospital San Pedro de Alcántara, Cáceres); L.M. Tamayo (Hospital Río Carrión, Palencia); J. Blanco (Complexo Hospitalario Xeral-Calde, Lugo); P. Galdós (Hospital General de Móstoles, Madrid); F. Barredo (Hospital de Torrecárdenas, Almería); A. Rodríguez (Hospital Santa María del Rosell, Cartagena); J. Castaño (Hospital Virgen de las Nieves, Granada); A. Bonet (Hospital Josep Trueta, Girona); M. Cerdá (Hospital de la Creu Roja, L'Hospitalet de Llobregat, Barcelona); A. Torres (UVIR, Hospital Clínic i Provincial, Barcelona); F. Pérez F (Fundación Jiménez Díaz, Madrid); J.M. Flores (UCI Traumatología, Hospital Virgen del Rocío, Sevilla); R. Diego (Hospital General Universitario, Valencia); C. Fernández (Complejo Hospitalario Insalud, León); A. Mas (Centre Hospitalari i Cardiologic, Manresa, Barcelona); F. Ruiz (Hospital Ciudad de Jaén, Jaén); C. León, (Hospital Nuestra Señora de Valme, Sevilla); M. Casanovas (Hospital de Igualada, Igualada, Barcelona); E.A. Sanz (Hospital Santa Ana, Motril, Granada); J.A. Artola (Hospital Naval de San Carlos, Cádiz); M.P. Luque (UCI de Traumatología, Hospital Clínico Univresitario, Zaragoza); C. Palazón (Hospital General Universitario, Murcia); C. Sotillo (Hospital Gregorio Marañón, Madrid); A. Bisbal (Policlínica Miramar, Palma de Mallorca); M.J. Huertos (Hospital de Puerto Real, Cádiz); F. Esteban (Hospital Sant Joan de Reus, Reus, Tarragona); P. Ugarte (Hospital Marqués de Valdecilla, Santander); R. Giral (Hospital General Yagüe, Burgos); V. González (Hospital Miguel Servet, Zaragoza); M.J. Serralta (Hospital San Juan, Alicante); A. Cercas (Hospital de Jerez, Cádiz); A. Nebra (Hospital Clínico Universitario, Zaragoza); C. Castillo (Hospital Txagorritxu, Vitoria-Gasteiz); A. Cercas (Hospital de Jerez, Cádiz); A. Nebra (Hospital Clínico Universitario, Zaragoza); C. Castillo (Hospital Txagorritxu, Vitoria), A. Tejada (UCI Traumatología, Hospital Miguel Servet, Zaragoza) and J.I. Gómez (REA, Hospital Río Ortega, Valladolid), Spain.

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Álvarez-Lerma, F., Nolla-Salas, J., León, C. et al. Candiduria in critically ill patients admitted to intensive care medical units. Intensive Care Med 29, 1069–1076 (2003). https://doi.org/10.1007/s00134-003-1807-y

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  • DOI: https://doi.org/10.1007/s00134-003-1807-y

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