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. 2020 Oct 16;10(1):142.
doi: 10.1186/s13613-020-00755-8.

Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis

Maria Schroeder  1 , Theresa Weber  2 , Timme Denker  2 , Sarah Winterland  2 , Dominic Wichmann  2 , Holger Rohde  3 , Ann-Kathrin Ozga  4 , Marlene Fischer  2 , Stefan Kluge  2
Affiliations

Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis

Maria Schroeder et al. Ann Intensive Care. .

Abstract

Background: Despite advances in the management of bloodstream infections (BSI) caused by Candida spp., the mortality still remains high in critically ill patients. The worldwide epidemiology of yeast-related BSI is subject to changing species distribution and resistance patterns, challenging antifungal treatment strategies. The aim of this single-center study was to identify predictors of mortality after 28 and 180 days in a cohort of mixed surgical and medical critically ill patients with candidemia.

Methods: Patients, who had been treated for laboratory-confirmed BSI caused by Candida spp. in one of 12 intensive care units (ICU) at a University hospital between 2008 and 2017, were retrospectively identified. We retrieved data including clinical characteristics, Candida species distribution, and antifungal management from electronic health records to identify risk factors for mortality at 28 and 180 days using a Cox regression model.

Results: A total of 391 patients had blood cultures positive for Candida spp. (incidence 4.8/1000 ICU admissions). The mortality rate after 28 days was 47% (n = 185) and increased to 60% (n = 234) after 180 days. Age (HR 1.02 [95% CI 1.01-1.03]), a history of liver cirrhosis (HR 1.54 [95% CI 1.07-2.20]), septic shock (HR 2.41 [95% CI 1.73-3.37]), the Sepsis-related Organ Failure Assessment score (HR 1.12 [95% CI 1.07-1.17]), Candida score (HR 1.25 [95% CI 1.11-1.40]), and the length of ICU stay at culture positivity (HR 1.01 [95% CI 1.00-1.01]) were significant risk factors for death at 180 days. Patients, who had abdominal surgery (HR 0.66 [95% CI 0.48-0.91]) and patients, who received adequate (HR 0.36 [95% CI 0.24-0.52]) or non-adequate (HR 0.31 [95% CI 0.16-0.62]) antifungal treatment, had a reduced mortality risk compared to medical admission and no antifungal treatment, respectively.

Conclusions: The mortality of critically ill patients with Candida BSI is high and is mainly determined by disease severity, multiorgan dysfunction, and antifungal management rather than species distribution and susceptibility. Our results underline the importance of timely treatment of candidemia. However, controversies remain on the optimal definition of adequate antifungal management.

Keywords: Antifungal agents; Bloodstream infection; Candida species; Candidemia; Critically ill patients; Echinocandin; Fluconazole; Intensive care unit.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow of participants throughout the study. “Accessible for antifungal treatment” refers to patients, who were not transferred or died prior to diagnosis of bloodstream infection caused by Candida spp
Fig. 2
Fig. 2
Distribution of Candida albicans versus non-albicans Candida spp. between 2008 and 2017
Fig. 3
Fig. 3
Antifungal management in 391 critically ill patients with Candida-induced bloodstream infection. aNumbers do not add up to 296 because more than one criterion was found in some patients. bRefers to patients, who died or were transferred to another hospital/rehabilitation facility, before microbiological results were obtained. cCandida spp. was not susceptible to antifungal substance administered
See this image and copyright information in PMC

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