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Fungal colonization and/or infection in non-neutropenic critically ill patients: results of the EPCAN observational study

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Abstract

The purpose of this paper is to determine the incidence of fungal colonization and infection in non-neutropenic critically ill patients and to identify factors favoring infection by Candida spp. A total of 1,655 consecutive patients (>18 years of age) admitted for ≥7 days to 73 medical-surgical Spanish intensive care units (ICUs) participated in an observational prospective cohort study. Surveillance samples were obtained once a week. One or more fungi were isolated in different samples in 59.2% of patients, 94.2% of which were Candida spp. There were 864 (52.2%) patients with Candida spp. colonization and 92 (5.5%) with proven Candida infection. In the logistic regression analysis risk factors independently associated with Candida spp. infection were sepsis (odds ratio [OR] = 8.29, 95% confidence interval [CI] 5.07–13.6), multifocal colonization (OR = 3.49, 95% CI 1.74–7.00), surgery (OR = 2.04, 95% CI 1.27–3.30), and the use of total parenteral nutrition (OR = 4.37, 95% CI 2.16–8.33). Patients with Candida spp. infection showed significantly higher in-hospital and intra-ICU mortality rates than those colonized or non-colonized non-infected (P < 0.001). Fungal colonization, mainly due to Candida spp., was documented in nearly 60% of non-neutropenic critically ill patients admitted to the ICU for more than 7 days. Proven candidal infection was diagnosed in 5.5% of cases. Risk factors independently associated with Candida spp. infection were sepsis, multifocal colonization, surgery, and the use of total parenteral nutrition.

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Acknowledgments

The authors thank Dr. Marta Pulido for editing the manuscript and for the editorial assistance.

Author information

Authors and Affiliations

  1. Servicio de Ciudados Críticos y Urgencias, Hospital Universitario de Valme, Universidad de Sevilla, Carretera de Cádiz s/n, 41014, Sevilla, Spain

    C. León

  2. Servicio de Medicina Intensiva, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain

    F. Álvarez-Lerma & J. Nolla

  3. Servicio de Medicina Intensiva, Hospital Universitario Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain

    S. Ruiz-Santana

  4. Servicio de Medicina Intensiva, Hospital General de Catalunya, Sant Cugat del Vallés, Barcelona, Spain

    M. Á. León

  5. Unidad de Cuidados Intensivos, Clínica Rotger, Palma de Mallorca, Spain

    R. Jordá

  6. Departamento de Matemáticas, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain

    P. Saavedra

  7. Servicio de Medicina Intensiva, Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    M. Palomar

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Consortia

The EPCAN Study Group

Corresponding author

Correspondence to C. León.

Additional information

Members of 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 (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 (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 Universitario, 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.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

Analysis and interpretation of data: Cristóbal León, Francisco Álvarez-Lerma, Sergio Ruiz-Santana, Pedro Saavedra.

Drafting of the article

Cristóbal León, Francisco Álvarez-Lerma, María Ángeles León, Sergio Ruiz-Santana, Pedro Saavedra.

Critical revision of the article for important intellectual content

Cristóbal León, Francisco Álvarez-Lerma, Sergio Ruiz-Santana, Pedro Saavedra, Mercedes Palomar.

Provision of study materials or patients

Cristóbal León, Francisco Álvarez-Lerma, María Ángeles León, Joan Nolla, Ricard Jordà, Merceces Palomar.

Statistical expertise

Sergio Ruiz-Santana, Pedro Saavedra.

Obtaining of funding

Cristóbal León, Mercedes Palomar.

Administrative, technical or logistic support

Cristóbal Léon, María Ángeles León, Joan Nolla, Ricard Jordà, Mercedes Palomar.

Collection and assembly of data

Cristóbal León, Francisco Álvarez-Lerma, Sergio Ruiz-Santana, Pedro Saavedra, Mercedes Palomar.

Financial disclosure

This study was supported by Gilead Sciences, Madrid, Spain. The sponsor had no role in the design and execution of the study, analysis and interpretation of data, or the writing of the manuscript, and was completely uninvolved in authorship and editorial decisions.

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León, C., Álvarez-Lerma, F., Ruiz-Santana, S. et al. Fungal colonization and/or infection in non-neutropenic critically ill patients: results of the EPCAN observational study. Eur J Clin Microbiol Infect Dis 28, 233–242 (2009). https://doi.org/10.1007/s10096-008-0618-z

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