Worrisome trends in incidence and mortality of candidemia in intensive care units Paris area, 2002–2010Report as inadecuate




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Intensive Care Medicine

, Volume 40, Issue 9, pp 1303–1312

First Online: 06 August 2014Received: 30 May 2014Accepted: 14 July 2014

Abstract

PurposeTo analyze trends in incidence and mortality of candidemia in intensive care units ICUs vs. non-ICU hospitalized patients and to determine risk factors for infection by specific species and for death.

MethodsActive hospital-based surveillance program of incident episodes of candidemia due to common species in 24 tertiary care hospitals in the Paris area, France between October 2002 and September 2010.

ResultsAmong 2,507 adult cases included, 2,571 Candida isolates were collected and species were C. albicans 56 %, C. glabrata 18.6 %, C. parapsilosis 11.5 %, C. tropicalis 9.3 %, C. krusei 2.9 %, and C. kefyr 1.8 %. Candidemia occurred in ICU in 1,206 patients 48.1 %. When comparing ICU vs. non-ICU patients, the former had significantly more frequent surgery during the past 30 days, were more often preexposed to fluconazole and treated with echinocandin, and were less frequently infected with C. parapsilosis. Risk factors and age remained unchanged during the study period. A significant increased incidence in the overall population and ICU was found. The odds of being infected with a given species in ICU was influenced by risk factors and preexposure to fluconazole and caspofungin. Echinocandins initial therapy increased over time in ICU 4.6 % first year of study, to 48.5 % last year of study, p < 0.0001. ICU patients had a higher day-30 death rate than non-ICU patients odds ratio OR 2.12; 95 % confidence interval CI 1.66–2.72; p < 0.0001. The day-30 and early
ConclusionsThe availability of new antifungals and the publication of numerous guidelines did not prevent an increase of candidemia and death in ICU patients in the Paris area.

KeywordsCandida Echinocandins Fluconazole Hematological malignancy Intensive care unit Epidemiology Risk factors Non-albicans species The group’s members are listed in the Appendix.

Take-home message: Neither the availability of new antifungals nor the publication of numerous guidelines prevented an increase of C. albicans candidemia and death in ICU patients between 2002 and 2010 in the Paris area.

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Author: Olivier Lortholary - Charlotte Renaudat - Karine Sitbon - Yoann Madec - Lise Denoeud-Ndam - Michel Wolff - Arnaud Fontanet

Source: https://link.springer.com/







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