| Contributors: |
Keth, Th; Azoulay, E; Echeverria, Pm; Vincent, Jl; Collaboratorsmargarit, A; Valentini, R; Alan Javier, Z; Bevilacqua, C; Curone, M; Rabuffetti, R; Comignani, P; Torres Boden, M; Chertcoff, F; Cardonatti, G; Adén, F; Marcos, L; Dónofrio, M; Fernández, R; Lamberghini, R; Balasini, S; Teves, J; Las Heras, M; Sinner, J; Ceraso, D; Curcio, D; Aguilar, L; Weller, C; Cardonnet, L; Santa Cruz, R; Manrique, E; Bernardez, D; Iolster, T; Chiappero, G; Ramos, P; Vergara, J; Moine, I; Ilutovich, S; Jannello, G; Waschbusch, M; Rios Picaza, G; Raimondi, A; Miriam, M; Lovesio, C; Caridi, M; Leong, T; Orford, N; Reece, G; Ernest, D; Hawker, F; Tan, J; Giannellis, C; Ihle, B; Bersten, A; Mcinnes, J; Tallott, M; Mcfadyen, B; Vibert, J; Parr, M; Tran, K; Sutton, J; Webb, S; Groves, N; Cole, L; Long, D; Bass, F; Erickson, S; Lipman, J; Delzoppo, C; Thomas, J; Dobb, G; Daley, M; Roberts, B; Santamaria, J; Young, J; Festa, M; Holland, R; Mullany, D; Williams, P; Corkeron, M; Gales, M; Banerjee, A; Yung, M; Mutz, N; Hiesmayr, M; Faybik, P; Fitzgerald, R; Firlinger, F; Zasmeta, G; Zink, M; Sieber, W; Hildegard, J; Bakondy, R; Schlieber, J; Filzwieser, G; Beer, R; Joannidis, M |
| Description: |
To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. DESIGN: A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge. SETTING: EPIC II included 1265 intensive care units in 76 countries. PATIENTS: Patients in participating intensive care units on study day. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Of the 14,414 patients in EPIC II, 99 patients had Candida bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstream infections. Candida albicans (n = 70) was the predominant species. Primary therapy included monotherapy with fluconazole (n = 39), caspofungin (n = 16), and a polyene-based product (n = 12). Combination therapy was infrequently used (n = 10). Compared with patients with Gram-positive (n = 420) and Gram-negative (n = 264) bloodstream infections, patients with candidemia were more likely to have solid tumors (p < .05) and appeared to have been in an intensive care unit longer (14 days [range, 5-25 days], 8 days [range, 3-20 days], and 10 days [range, 2-23 days], respectively), but this difference was not statistically significant. Severity of illness and organ dysfunction scores were similar between groups. Patients with Candida bloodstream infections, compared with patients with Gram-positive and Gram-negative bloodstream infections, had the greatest crude intensive care unit mortality rates (42.6%, 25.3%, and 29.1%, respectively) and longer intensive care unit lengths of stay (median [interquartile range]) (33 days [18-44], 20 days [9-43], ... |