Epidemiology, management and risk factors for death of invasive Candida infections in critical care units: a multicentre, prospective, observational study in France (20052006)
Abstract number: O455
Lortholary O., Gangneux J.P., Montravers P., Mira J.P., Gouin F., Sollet J.P., Carlet J., Reynes J., Régnier B., Rosenheim M., Leroy O.
Objective: To describe the evolving epidemiology, management and risk factors for death of invasive Candida spp. infections in intensive care units (ICUs) in France
Methods: This country-based, prospective, observational study (AmarCand study) was carried out in 101 ICUs. 271 adult patients with proven invasive Candida spp. infection who received a systemic antifungal therapy were included between October 2005 and May 2006.
Results: The study included 107 (39.5%) patients with isolated candidaemia, 87 (32.1%) with invasive candidiasis without candidaemia, and 77 (28.4%) with invasive candidiasis and candidaemia. With regards to risk factors, 76% of patients had mechanical ventilation, 97% were catheterised, 59% had had prior antibiotherapy, 21% were immunocompromised, and 34% had a malignancy. C. albicans accounted for 57.0% of the causative species, followed by C. glabrata (16.7%), C. parapsilosis (7.5%), C. krusei (5.2%) and C. tropicalis (4.9%). In 17.1% of the cases, the causative species was less susceptible or resistant to fluconazole. Fluconazole was the empiric treatment most commonly initiated (65.7%), followed by caspofungin (18.1%), voriconazole (5.5%), or amphotericin B (3.3%). The case fatality ratio at the end of ICU stay was 45.9%. Multivariate analysis showed that factors independently associated with death in ICU were: diabetes mellitus (odds ratio [OR] 4.51, 95% confidence interval [CI] 1.7211.79, p = 0.002), immunosuppression (OR 2.63, 95% CI 1.355.11, p = 0.0045), invasive mechanical ventilation (OR 2.54, 95% CI 1.334.82, p = 0.0045), and body temperature >38.2°C (reference: 36.538.2°C, OR 0.36, 95% CI 0.170.77, p = 0.008).
Conclusion: The AmarCand study results show that 68% of patients with systemic candidiasis in ICU present with candidaemia. C. albicans remains the most frequent causative species. Reduced susceptibility to fluconazole is observed in a large number of Candida spp. isolates. 84% of ICU adult patients receive fluconazole or caspofungin as first line therapy and mortality of invasive candidiasis in ICU remains dramatically elevated.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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