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Multicenter Study
. 2024 Oct;52(5):1733-1743.
doi: 10.1007/s15010-024-02222-z. Epub 2024 Mar 12.

Role of source control in critically ill candidemic patients: a multicenter retrospective study

Markos Marangos  1 , Petros Ioannou  2 , Laurence Senn  3 , Anastasia Spiliopoulou  4 , Sotiris Tzalis  2 , Fevronia Kolonitsiou  4 , Maria Valta  5 , Sofia Kokkini  6 , Jean-Luc Pagani  7 , Dimitra Stafylaki  8 , Fotini Paliogianni  4 , Fotini Fligou  5 , Diamantis P Kofteridis  2 , Frédéric Lamoth  3   9 , Matthaios Papadimitriou-Olivgeris  10   11
Affiliations
Multicenter Study

Role of source control in critically ill candidemic patients: a multicenter retrospective study

Markos Marangos et al. Infection. 2024 Oct.

Abstract

Purpose: Candidemia is associated with high mortality especially in critically ill patients. Our aim was to identify predictors of mortality among critically ill patients with candidemia with a focus on early interventions that can improve prognosis.

Methods: Multicenter retrospective study.

Setting: This retrospective study was conducted in Intensive Care Units from three European university hospitals from 2015 to 2021. Adult patients with at least one positive blood culture for Candida spp. were included. Patients who did not require source control were excluded. Primary outcome was 14-day mortality.

Results: A total of 409 episodes of candidemia were included. Most candidemias were catheter related (173; 41%), followed by unknown origin (170; 40%). Septic shock developed in 43% episodes. Overall, 14-day mortality rate was 29%. In Cox proportional hazards regression model, septic shock (P 0.001; HR 2.20, CI 1.38-3.50), SOFA score ≥ 10 points (P 0.008; HR 1.83, CI 1.18-2.86), and prior SARS-CoV-2 infection (P 0.003; HR 1.87, CI 1.23-2.85) were associated with 14-day mortality, while combined early appropriate antifungal treatment and source control (P < 0.001; HR 0.15, CI 0.08-0.28), and early source control without appropriate antifungal treatment (P < 0.001; HR 0.23, CI 0.12-0.47) were associated with better survival compared to those without neither early appropriate antifungal treatment nor source control.

Conclusion: Early source control was associated with better outcome among candidemic critically ill patients.

Keywords: Candida albicans; Antifungal treatment; Catheter removal; Intensive Care Unit; SARS-CoV-2; Sepsis; Source control.

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Conflict of interest statement

Frederic Lamoth declares research grants from Funginos, Novartis, Pfizer and Merck, and speaker honoraria from Gilead. All contracts were made with and fees paid to his institution (LUH). The remaining authors have no competing interests to declare that are relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Flowchart of included patents
Fig. 2
Fig. 2
Kaplan–Meier curves illustrating the survival probability of episodes with candidemia based on early appropriate antifungal treatment and early source control in the 390 cases that survived at least 72 h from candidemia onset. Patients in Group 2 (those who received only early appropriate antifungal treatment) exhibited a similar outcome (P 0.120) to those in Group 1 (individuals who received neither early appropriate antifungal treatment nor early source control). However, both Groups 1 and 2 experienced worse outcomes (P < 0.001) compared to Groups 3 (patients with only early source control) and 4 (individuals who received both early appropriate antifungal treatment and early source control). There was no significant difference observed when comparing Groups 3 and 4
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