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Crit Care Med. 2008 Jul;36(7):2034-9. doi: 10.1097/CCM.0b013e3181760f42.

Candidemia in nonneutropenic critically ill patients: risk factors for non-albicans Candida spp.

Author information

1
Princess Alexandra Hospital, Queensland, Australia. geoffrey_playford@health.qld.gov.au

Abstract

OBJECTIVE:

The objective of this study was to determine the clinical features associated with candidemia caused by non-albicans Candida spp. and with potentially fluconazole-resistant Candida spp. (C. glabrata and C. krusei) among candidemic intensive care unit patients.

DESIGN:

The authors conducted a nationwide prospective cohort study.

SETTING:

The study was conducted in Australian intensive care units.

PATIENTS:

All patients with intensive care unit-acquired candidemia over a 3-yr period were included in the study.

MEASUREMENTS:

Clinical risk factors occurring up to 30 days before candidemia, Candida spp. associated with candidemia, and outcomes were determined. Risk factors associated with either non-albicans Candida spp. or with potentially fluconazole-resistant Candida spp. (C. glabrata or C. krusei) were assessed using multivariate logistic regression.

MAIN RESULTS:

Among 179 episodes of intensive care unit-acquired candidemia, C. albicans accounted for 62%, C. glabrata 18%, C. krusei 4%, and other Candida spp. 16%. Independently significant variables associated with non-albicans Candida bloodstream infection included recent prior gastrointestinal surgery (adjusted odds ratio, 2.87; 95% confidence interval, 1.68-4.91) and recent prior systemic antifungal exposure (4.6; 1.36-15.53). Those associated with potentially fluconazole-resistant candidemia included recent prior gastrointestinal surgery (3.31; 1.79-6.11) and recent prior fluconazole exposure (5.47; 1.23-24.32). No significant differences in outcomes were demonstrated for non-albicans or potentially fluconazole-resistant candidemia.

CONCLUSIONS:

Among candidemic intensive care unit patients, prior gastrointestinal surgery and systemic antifungal exposure were significantly associated with both a non-albicans Candida spp. and a potentially fluconazole-resistant Candida spp.

PMID:
18552700
DOI:
10.1097/CCM.0b013e3181760f42
[Indexed for MEDLINE]

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