Risk factors for candidemia: a prospective matched case-control study.
- Poissy J Current affiliation : Univ. Lille, Inserm U1285, CHU Lille, Pôle de réanimation, NRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, F-59000, Lille, France.
- Damonti L Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
- Bignon A Surgical Intensive Care Unit, University Hospital of Lille, F-59000, Lille, France.
- Khanna N Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital of Basel, Basel, Switzerland.
- Von Kietzell M Infectious Diseases Department, Cantonal Hospital of Saint Gallen, St. Gallen, Switzerland.
- Boggian K Infectious Diseases Department, Cantonal Hospital of Saint Gallen, St. Gallen, Switzerland.
- Neofytos D Transplant Infectious Diseases Unit, University Hospitals of Geneva, Geneva, Switzerland.
- Vuotto F Infectious Diseases Department, University Hospital of Lille, F-59000, Lille, France.
- Coiteux V Hematological Disorders Department, University Hospital and University of Lille, F-59000, Lille, France.
- Artru F Digestive Intensive Care Department, University Hospital and University of Lille, F-59000, Lille, France.
- Zimmerli S Department of Infectious Diseases Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Pagani JL Adult Intensive Care Service, University Hospital and University of Lausanne, Lausanne, Switzerland.
- Calandra T Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
- Sendid B Inserm, U995-2 "Fungal Associated Invasive and Inflammatory Diseases", F-59000, Lille, France.
- Poulain D Inserm, U995-2 "Fungal Associated Invasive and Inflammatory Diseases", F-59000, Lille, France.
- van Delden C Transplant Infectious Diseases Unit, University Hospitals of Geneva, Geneva, Switzerland.
- Lamoth F Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
- Marchetti O Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
- Bochud PY Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, rue du Bugnon 46, CH-1011, Lausanne, Switzerland. Pierre-Yves.Bochud@chuv.ch.
- 2020-03-20
Published in:
- Critical care (London, England). - 2020
Antibiotics
Candidemia
Central venous catheter
Risk factors
Scores
Total parenteral nutrition
Aged
Antifungal Agents
Candidemia
Case-Control Studies
Central Venous Catheters
Cross Infection
Female
France
Hospitalization
Humans
Intensive Care Units
Male
Middle Aged
Prospective Studies
Risk Factors
Switzerland
English
BACKGROUND
Candidemia is an opportunistic infection associated with high morbidity and mortality in patients hospitalized both inside and outside intensive care units (ICUs). Identification of patients at risk is crucial to ensure prompt antifungal therapy. We sought to assess risk factors for candidemia and death, both outside and inside ICUs.
METHODS
This prospective multicenter matched case-control study involved six teaching hospitals in Switzerland and France. Cases were defined by positive blood cultures for Candida sp. Controls were matched to cases using the following criteria: age, hospitalization ward, hospitalization duration, and, when applicable, type of surgery. One to three controls were enrolled by case. Risk factors were analyzed by univariate and multivariate conditional regression models, as a basis for a new scoring system to predict candidemia.
RESULTS
One hundred ninety-two candidemic patients and 411 matched controls were included. Forty-four percent of included patients were hospitalized in ICUs, and 56% were hospitalized outside ICUs. Independent risk factors for candidemia in the ICU population included total parenteral nutrition, acute kidney injury, heart disease, prior septic shock, and exposure to aminoglycoside antibiotics. Independent risk factors for candidemia in the non-ICU population included central venous catheter, total parenteral nutrition, and exposure to glycopeptides and nitroimidazoles. The accuracy of the scores based on these risk factors is better in the ICU than in the non-ICU population. Independent risk factors for death in candidemic patients included septic shock, acute kidney injury, and the number of antibiotics to which patients were exposed before candidemia.
DISCUSSION
While this study shows a role for known and novel risk factors for candidemia, it specifically highlights important differences in their distribution according to the hospital setting (ICU versus non-ICU).
CONCLUSION
This study provides novel risk scores for candidemia accounting for the hospital setting and recent progress in patients' management strategies and fungal epidemiology.
Candidemia is an opportunistic infection associated with high morbidity and mortality in patients hospitalized both inside and outside intensive care units (ICUs). Identification of patients at risk is crucial to ensure prompt antifungal therapy. We sought to assess risk factors for candidemia and death, both outside and inside ICUs.
METHODS
This prospective multicenter matched case-control study involved six teaching hospitals in Switzerland and France. Cases were defined by positive blood cultures for Candida sp. Controls were matched to cases using the following criteria: age, hospitalization ward, hospitalization duration, and, when applicable, type of surgery. One to three controls were enrolled by case. Risk factors were analyzed by univariate and multivariate conditional regression models, as a basis for a new scoring system to predict candidemia.
RESULTS
One hundred ninety-two candidemic patients and 411 matched controls were included. Forty-four percent of included patients were hospitalized in ICUs, and 56% were hospitalized outside ICUs. Independent risk factors for candidemia in the ICU population included total parenteral nutrition, acute kidney injury, heart disease, prior septic shock, and exposure to aminoglycoside antibiotics. Independent risk factors for candidemia in the non-ICU population included central venous catheter, total parenteral nutrition, and exposure to glycopeptides and nitroimidazoles. The accuracy of the scores based on these risk factors is better in the ICU than in the non-ICU population. Independent risk factors for death in candidemic patients included septic shock, acute kidney injury, and the number of antibiotics to which patients were exposed before candidemia.
DISCUSSION
While this study shows a role for known and novel risk factors for candidemia, it specifically highlights important differences in their distribution according to the hospital setting (ICU versus non-ICU).
CONCLUSION
This study provides novel risk scores for candidemia accounting for the hospital setting and recent progress in patients' management strategies and fungal epidemiology.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1186/s13054-020-2766-1
- PMID 32188500
- Persistent URL
- https://folia.unifr.ch/global/documents/201464
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