alexa Candida albicans versus non-albicans intensive care unit-acquired bloodstream infections: differences in risk factors and outcome.


Journal of Vaccines & Vaccination

Author(s): Dimopoulos G, Ntziora F, Rachiotis G, Armaganidis A, Falagas ME

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Abstract OBJECTIVE: In this study we sought to identify differences in risk factors and outcome of critically ill patients with Candida albicans and non-albicans candidemia. METHODS: Nonimmunosuppressed, nonneutropenic patients with candidemia diagnosed after intensive care unit (ICU) admission were included in a prospective observational study in a medical-surgical ICU at a tertiary academic hospital in Athens, Greece. RESULTS: During the study period (January 2001 to December 2005), 56 candidemia episodes in 1037 ICU admissions were included (5.4\%). Of these patients, 36/56 (64.3\%) had candidemia due to C. albicans and 20/56 (35.7\%) due to non-albicans species (8/56 [14.3\%] C. glabrata, 6/56 [10.7\%] C. tropicalis, 3/56 [5.4\%] C. parapsilosis, 1/56 [1.8\%] C. lusitaniae, 1/56 [1.8\%] C. krusei and 1/56 [1.8\%] C. dubliniensis). Administration of glucocorticosteroids, central venous catheter placement, and preexisting candiduria were independently associated with candidemia due to C. non-albicans species (Odds ratio [OR]: 45.1, 95\% confidence interval [CI]: 3.0-669.9; OR: 26.2, 95\% CI: 2.1-334.8; and OR: 16.5, 95\% CI: 1.6-173.9, respectively). The treatment response rate differed significantly between patients with C. albicans and patients with C. non-albicans bloodstream infections (29/36 [80.6\%] vs 9/20 [45\%], P = 0.006). Overall mortality was higher in patients with non-albicans species than C. albicans bloodstream infections (18/20 [90\%] vs 19/36 [52.8\%], P = 0.005). Multivariable logistic regression analysis revealed that candidemia due to non-albicans species was independently associated with death (OR: 6.7, 95\% CI: 1.2-37.7). CONCLUSIONS: In the subset of critically ill nonimmunosuppressed patients, candidemia caused by non-albicans species occurred more frequently in those with medical devices or receiving steroids. Candidemia due to non-albicans species was also associated with higher mortality. This article was published in Anesth Analg and referenced in Journal of Vaccines & Vaccination

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