Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005-2006).
- Type de publi. : Article dans une revue
- Date de publi. : 01/05/2009
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Auteurs :
Olivier LeroyJean-Pierre GangneuxPhilippe MontraversJean-Paul MiraFrançois GouinJean-Pierre SolletJean CarletJacques ReynesMichel RosenheimBernard RegnierOlivier LortholaryNon Renseigné
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Organismes :
Service de Réanimation Médicale et des Maladies Infectieuses
Signalisation et Réponses aux Agents Infectieux et Chimiques
Régulations des équilibres fonctionnels du foie normal et pathologique
Département anesthésie-réanimation chirurgicale
Institut Cochin
Physiopathologie des Adaptations Nutritionnelles
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
service de réanimation polyvalente
Réanimation Médico-Chirurgicale
Centre d'infectiologie Necker-Pasteur [CHU Necker]
Mycologie moléculaire
- Publié dans Critical Care Medicine le 31/10/2020
Résumé : OBJECTIVE: To describe the evolving epidemiology, management, and risk factors for death of invasive Candida infections in intensive care units (ICUs). DESIGN: Prospective, observational, national, multicenter study. SETTING: One hundred eighty ICUs in France. PATIENTS: Between October 2005 and May 2006, 300 adult patients with proven invasive Candida infection who received systemic antifungal therapy were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: One hundred seven patients (39.5%) with isolated candidemia, 87 (32.1%) with invasive candidiasis without documented candidemia, and 77 (28.4%) with invasive candidiasis and candidemia were eligible. In 37% of the cases, candidemia occurred within the first 5 days after ICU admission. C. albicans accounted for 57.0% of the isolates, followed by C. glabrata (16.7%), C. parapsilosis (7.5%), C. krusei (5.2%), and C. tropicalis (4.9%). In 17.1% of the isolates, the causative Candida was less susceptible or resistant to fluconazole. Fluconazole was the empirical treatment most commonly introduced (65.7%), followed by caspofungin (18.1%), voriconazole (5.5%), and amphotericin B (3.7%). After identification of the causative species and susceptibility testing results, treatment was modified in 86 patients (31.7%). The case fatality ratio in ICU was 45.9% and did not differ significantly according to the type of episode. Multivariate analysis showed that factors independently associated with death in ICU were type 1 diabetes mellitus (odds ratio [OR] 4.51; 95% confidence interval [CI] 1.72-11.79; p = 0.002), immunosuppression (OR 2.63; 95% CI 1.35-5.11; p = 0.0045), mechanical ventilation (OR 2.54; 95% CI 1.33-4.82; p = 0.0045), and body temperature >38.2 degrees C (reference, 36.5-38.2 degrees C; OR 0.36; 95% CI 0.17-0.77; p = 0.008). CONCLUSIONS: More than two thirds of patients with invasive candidiasis in ICU present with candidemia. Non-albicans Candida species reach almost half of the Candida isolates. Reduced susceptibility to fluconazole is observed in 17.1% of Candida isolates. Mortality of invasive candidiasis in ICU remains high.
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