Ayşe Serra ÖZEL, Lütfiye Nilsun ALTUNAL, Buket Erturk SENGEL, Muge ASLAN, Mehtap AYDIN

Predictors of outcomes in patients with candidemia in an Intensive Care Unit

Objective: Candidemia is a life-threatening infection that causes high mortality rates in intensive care units (ICUs). This study aims to evaluate predictors of the outcome of patients with candidemia in ICU. Patients and Methods: This observational, retrospective study included patients with Candida bloodstream infection (BSI) in ICUs between 6 years of the episode. A binary logistic regression analysis was conducted to inspect the association with mortality. Results: The median age of 74 patients was 68.5, and 53.8% were men. C. parapsilosis was the most frequently isolated fungal species. The 30-day mortality rate was 50%. In the logistic regression model the Acute Physiology and Chronic Health Evaluation (APACHE) II score, positive blood culture on the seventh day, inotropes needed on the day of blood culture positivity, and ventilator-associated pneumonia (VAP) were significant risk factors for the outcome of patients. There was no difference in mortality between an early start of antifungal treatment or central venous catheter removal time. Conclusion: A shift to C. parapsilosis is observed in this study. Host-related factors such as APACHE II score, need for mechanical ventilation or need for inotropes affect mortality more than early treatment and source control in patients with Candida BSI.

Keywords:

Candida, Candidemia, Intensive Care Unit, Mortality, Outcome,

PDF

___

Tsay S, Williams S, Mu Y, et al. 363. National burden of candidemia, United States, 2017. Forum Infect Dis 2018;5:142- 3. doi: 10.1093/ofid/ofy210.374
Kronen R, Hsueh K, Lin C, Powderly WG, Spec A. creation and assessment of a clinical predictive calculator and mortality associated with Candida krusei bloodstream ınfections. Open Forum Infect Dis 2018;5:253. doi: 10.1093/ofid/ofx253
Kollef M, Micek S, Hampton N, Doherty JA, Kumar A. Septic shock attributed to Candida infection: importance of empiric therapy and source control. Clin Infect Dis 2012;54:1739-46. doi: 10.1093/cid/cis305
Giacobbe DR, Maraolo AE, Simeon V, et al. Changes in the relative prevalence of candidaemia due to non-albicans Candida species in adult in-patients: A systematic review, meta-analysis and meta-regression. Mycoses 2020;63:334-42. doi: 10.1111/myc.13054
Bartoletti M, Giannella M, Lewis R, et al. A prospective multicentre study of the epidemiology and outcomes of bloodstream infection in cirrhotic patients. Clin Microbiol Infect 2018;24:546-1. doi: 10.1016/j.cmi.2017.08.001
Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of Candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicrob. Agents Chemother 2005;49:3640-45. doi:10.1128/AAC.49.9.3640-3645.2005
Grim SA, Berger K, Teng C, et al. Timing of susceptibilitybased antifungal drug administration in patients with Candida bloodstream infection: correlation with outcomes. J Antimicrob Chemother 2012;67:707-14. doi: 10.1093/jac/ dkr511
Ala-Houhala M, Valkonen M, Kolho E, Friberg N. Clinical and microbiological factors associated with mortality in candidemia in adult patients 2007-2016. Infect Dis 2019;51:824-30. doi: 10.1080/23744.235.2019.1662941
Ohki S, Shime N, Kosaka T, Fujita N. Impact of host – and early treatment-related factors on mortality in ICU patients with candidemia: a bicentric retrospective observational study. J Intensive Care 2020,8:30. doi:10.1186/s40560.020.00450-7
Nucci M, Anaissie E, Betts RF, et al. Early removal of central venous catheter in patients with candidemia does not improve outcome: analysis of 842 patients from 2 randomized clinical trials. Clin Infect Dis 2010;51:295-303. doi: 10.1086/653935
Clinical and Laboratory Standards Institute. Performance Standards for Antifungal Susceptibility Testing of Yeasts, 2nd ed.; CLSI Supplement M60; Clinical and Laboratory Standards Institute: Wayne, PA, USA, 2020; ISBN 978-1-68440-082-9.
Mazzanti S, Brescini L, Morroni G, et al. Candidemia in intensive care units over nine years at a large Italian university hospital: Comparison with other wards. PLoS One 2021;16:0252165. doi: 10.1371/journal.pone.0252165
Xiao Z, Wang Q, Zhu F, An Y. Epidemiology, species distribution, antifungal susceptibility and mortality risk factors of candidemia among critically ill patients: a retrospective study from 2011 to 2017 in a teaching hospital in China. Antimicrob Resist Infect Control 2019;8:89. doi: 10.1186/s13756.019.0534-2
Tukenmez Tigen E, Bilgin H, Perk GH, et al. Risk factors, characteristics, and outcomes of candidemia in an adult intensive care unit in Turkey. Am J Infect Control.2017;45:61-3. doi: 10.1016/j.ajic.2017.02.022
Karacaer Z, Oncul O, Turhan V, Gorenek L, Ozyurt M. A surveillance of nosocomial Candida infections: epidemiology and influences on mortalty in intensive care units. Pan Afr Med J 2014;19:398. doi: 10.11604/pamj.2014.19.398.4960
Puig-Asensio M, Pemán J, Zaragoza R, et al. Prospective Population Study on Candidemia in Spain (CANDIPOP) Project; Hospital Infection Study Group (GEIH); Medical Mycology Study Group (GEMICOMED) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC); Spanish Network for Research in Infectious Diseases. Impact of therapeutic strategies on the prognosis of candidemia in the ICU. Crit Care Med 2014;42:1423-32. doi: 10.1097/CCM.000.000.0000000221
Kutlu M, Sayın-Kutlu S, Alp-Cavus S, et al. Mortalityassociated factors of candidemia: a multi-center prospective cohort in Turkey. Eur J Clin Microbiol Infect Dis 2022;41:597- 607. doi: 10.1007/s10096.021.04394-0
Schwab F, Geffers C, Behnke M, Gastmeier P. ICU mortality following ICU-acquired primary bloodstream infections according to the type of pathogen: A prospective cohort study in 937 Germany ICUs (2006-2015). PLoS One 2018;13:0194210. doi: 10.1371/journal.pone.0194210
Atamna A, Eliakim-Raz N, Mohana J, et al. Predicting candidemia in the internal medicine wards: a comparison with gram-negative bacteremia-a retrospectives study. Diagn Microbiol Infect Dis 2019;95:80-3. doi: 10.1016/j. diagmicrobio.2019.04.007
Zatta M, Di Bella S, Giacobbe DR, et al. clinical features and mortality of nosocomial candidemia in very old patients: A multicentre Italian study. Gerontology 2020;66:532-41. doi: 10.1159/000510638
Jung IY, Jeong SJ, Kim YK, et al. A multicenter retrospective analysis of the antifungal susceptibility patterns of Candida species and the predictive factors of mortality in South Korean patients with candidemia. Medicine (Baltimore) 2020;99:e19494. doi:10.1097/MD.000.000.0000019494
Pfaller MA, Diekema DJ, Turnidge JD, Castanheira M, Jones RN. Twenty Years of the SENTRY Antifungal Surveillance Program: Results for Candida Species From 1997-2016. Open Forum Infect Dis 2019;6:79-94. doi: 10.1093/ofid/ofy358
Doi AM, Pignatari AC, Edmond MB, et al. Epidemiology and Microbiologic Characterization of Nosocomial Candidemia from a Brazilian National Surveillance Program. PLoS One 2016;11:0146909. doi: 10.1371/journal.pone.0146909 [24] Cortés JA, Montañez AM, Carreño-Gutiérrez AM, et al. Risk Factors for Mortality in Colombian Patients with Candidemia. J Fungi (Basel) 2021;7:442. doi:10.3390/jof7060442
Cleveland AA, Harrison LH, Farley MM, et al. Declining incidence of candidemia and the shifting epidemiology of Candida resistance in two US metropolitan areas, 2008-2013: results from population-based surveillance. PLoS ONE 2015; 10: e0120452. doi: 10.1371/journal.pone.0120452