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. 2020 Mar 18;24(1):109.
doi: 10.1186/s13054-020-2766-1.

Risk factors for candidemia: a prospective matched case-control study

Julien Poissy  1   2   3 , Lauro Damonti  3   4 , Anne Bignon  5 , Nina Khanna  6 , Matthias Von Kietzell  7 , Katia Boggian  7 , Dionysios Neofytos  8 , Fanny Vuotto  9 , Valérie Coiteux  10 , Florent Artru  11 , Stephan Zimmerli  4 , Jean-Luc Pagani  12 , Thierry Calandra  3 , Boualem Sendid  2   13 , Daniel Poulain  2   13 , Christian van Delden  8 , Frédéric Lamoth  3   14 , Oscar Marchetti  3   15 , Pierre-Yves Bochud  16 ; FUNGINOS; Allfun French Study Groups
Collaborators, Affiliations

Risk factors for candidemia: a prospective matched case-control study

Julien Poissy et al. Crit Care. .

Abstract

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.

Keywords: Antibiotics; Candidemia; Central venous catheter; Risk factors; Scores; Total parenteral nutrition.

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Conflict of interest statement

TC has been in an advisory board for Astellas, Basilea, Cidara, MSD, Sobi, Thermofisher, GE Healthcare, and in a Data Monitoring Board for Novartis. The other authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Risk scores for candidemia. Scoring values assigned to each variable (A1 and A2), resulting ROC curves with adjusted areas under the curve (aAUCs, B1 and B2) and single risk performance values (C1 and C2) are shown for patients inside and outside ICU, respectively. Se, Sp, LR+, and LR− stand for sensitivity, specificity, positive and negative likelihood ratios, respectively. The number of patients included in the calculation of score may be lower than the total number of patients due to missing co-variables in some individual patients
See this image and copyright information in PMC

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