Comparison of the epidemiology, risk factors, outcome and degree of organ failures of patients with candidemia acquired before or during ICU treatment

Ala-Kokko, Koskela Markku, Ohtonen Pasi, Ylipalosaari Pekka, Karhu Juha, Laurila Jouko, Syrjälä, Syrjälä Hannu

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• Publié par: biomed
• Publié le: 01 janvier 2012
• Nombre de lectures: 9
• Langue: English

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Ylipalosaariet al.Critical Care2012,16:R62 http://ccforum.com/content/16/2/R62

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Open Access

Comparison of the epidemiology, risk factors, outcome and degree of organ failures of patients with candidemia acquired before or during ICU treatment 1* 2 1 4 2 3 Pekka Ylipalosaari , Tero I AlaKokko , Juha Karhu , Markku Koskela , Jouko Laurila , Pasi Ohtonen and 1 Hannu Syrjälä

Abstract Introduction:The aim of this study was to compare the epidemiology, risk factors, severity and outcome of two types of ICUtreated candidemias: namely, ICUacquired candidemia (acquired after 48hour ICU stay) (ICUAC group), and those needing ICU treatment for candidemia acquired before ICU admission or during the first 48hour ICU stay (nonICUAC group). Methods:A retrospective cohort study was conducted between 2000 and 2009 in a mixed tertiary ICU among patients with bloodcultureconfirmed candidemia. Results:The study involved 82 patients (53 men). The ICUAC group consisted of 38 patients (46.3%) and the non ICUA group included 44 patients (53.6). The ICUAC group had undergone previous surgery more often and had ICU stays that were 3.7 times longer than the nonICUAC group, whose members more often had comorbidities (95.6% versus 73.7%,P= 0.001). The ICUAC group had significantly more frequent organ failures with cardiovascular, renal, central nervous and coagulation systems than the nonICUAC group. ICU, hospital and one year mortality rates did not differ between the groups (23%, 36.8% and 65.8%, respectively, in the ICUAC group and 26%, 44.4% and 64.4%, respectively, in the nonICUAC group). Among patients with APACHE II scores greater than 25, the ICUAC group had lower oneyear mortality (65.0% versus 87.5%). Among patients with APACHE II scores of 25 or less, the ICUAC group had higher mortality (66.7% versus 50.0).Candida albicanswas most common cause of candidemia in both groups (76.3% and 68.9%, respectively). Conclusions:More than half of the ICUtreated candidemias were acquired prior to admission to the ICU. Patients with ICU and nonICUacquired candidemias had different risk factors and different needs for ICU resources. Hospital mortality was similar in both groups; however, the groups had different mortality rates when the severity of disease and underlying diseases were taken into account.

Introduction Candida species are among the most common microbes causing severe infections in patients in ICUs. Recent Eur opean publications of the causes of bloodstream infec tions (BSI) have listed Candida species as between the fifth and tenth most common causative pathogen [1].

* Correspondence: [e-mail] 1 Department of Infection Control, Oulu University Hospital, Kajaanintie 50, Oulu, FIN90029 OYS, Finland Full list of author information is available at the end of the article

Candidemia is associated with increased overall morbid ity and attributable mortality, longer duration of ICU stay, as well as increased cost [25]. C. albicanshas been the most common isolate (60% to 70%) among patients with ICUacquired candidemia, fol lowed byC. glabrata(15% to 20%). Some publications have shown an increase of candidemias with nonalbicans Candidaspecies, although contrary results have also been published [4,610].

© 2012 Ylipalosaari et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.