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Multicenter Study
. 2025 Jul 5;29(1):281.
doi: 10.1186/s13054-025-05527-z.

Screening, prevalence, and risk factors for secondary localization during candidemia in intensive care unit patients: the French CandidICU multicenter study

Florian Reizine  1 , Juliette Henry  2 , Luc Desmedt  3 , Christophe Camus  4 , Valentin Coirier  4 , François Arrive  5 , Estelle Burban  6 , Gabriel Eustache  7 , Tony Belleville  8 , Antoine Marc  9 , Jolan Malherbe  10 , Pierre Bouju  11 , Paul Jaubert  12 , Olivier Lesieur  13 , Maxime Leclerc  14 , Pierre Fillâtre  15 , Aurélien Frérou  16 , Renaud Prével  2 , Nolwenn Mainguy  17 , Hélène Guegan  18   19 , Anne Cady  20 , Laurence Delhaes  21 , Sébastien Imbert  21 , Florent Morio  22 , Estelle Perraud  23 , Solène Le Gal  24 , Julie Bonhomme  25 , Marc Pihet  26 , Clarisse Dupin  27 , Damien Du Cheyron  10 , Yoann Launey  7 , Cécile Aubron  6 , Jean-Pierre Gangneux  28   29
Affiliations
Multicenter Study

Screening, prevalence, and risk factors for secondary localization during candidemia in intensive care unit patients: the French CandidICU multicenter study

Florian Reizine et al. Crit Care. .

Abstract

Background: Candidemia is a life-threatening fungal infection in intensive care unit (ICU) patients that can be complicated by secondary localization (SL). However, the prevalence, risk-factors, and outcomes of patients with secondary localization during candidemia remain poorly explored.

Methods: The CandidICU study was a retrospective multicenter cohort study conducted in 16 French ICUs. All adult patients hospitalized from 01-2015 to 01-2023 for candidemia were enrolled. We assessed the prevalence and risk-factors for SL. In addition, we explored the clinical course according to the screening and occurrence of SL.

Results: Among 492 patients hospitalized in ICU with at least one positive blood culture for Candida sp., 376 were screened for SL (76.4%). At least one SL was diagnosed in 82 patients (21.8%). Competing risk analysis identified the SAPSII score and the duration of positive blood cultures as independent risk factors for SL (sdHR 1.01 [95%CI 1.00-1.02]; p = 0.031 and sdHR 1.05 [95%CI 1.02-1.08]; p = 0.003, respectively). Age and Candida glabrata infection were protective factors against SL (sdHR 0.98 [95%CI 0.97-1.00]; p = 0.016 and sdHR 0.38 [95%CI 0.15-0.99]; p = 0.048, respectively). Finally, patients with SL received longer antifungal treatment (18 [11-30] versus 14 [6-18] days; p < 0.001) and had a higher rate of antifungal escalation (27.8% versus 12.3%; p = 0.002).

Conclusions: In this cohort, 76·4% of ICU patients with candidemia were screened for SL and at least one SL was diagnosed in 21·8%. The severity at ICU admission and duration of positive blood cultures were identified as independent risk factors for SL, whereas age and Candida glabrata infection were protective. Finally, the screening and occurrence of SL were associated with significant changes in the management of patients.

Keywords: Candidemia; Deep-seated tissue candidiasis; Endocarditis; Fundoscopy; ICU; Secondary localization.

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Conflict of interest statement

Declarations. Ethics considerations: The study was carried out in accordance with the ethical standards of the Declaration of Helsinki, and the database was approved by the local ethics committee [Comité d'éthique CHU Rennes N° 23.99]. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the study population
Fig. 2
Fig. 2
Weighted Survival curves of the overall population according to secondary localisation screening with exclusion of patients dying within the first five days after candidemia onset
See this image and copyright information in PMC

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