Abstract
BackgroundTo characterize and identify prognostic factors for 28-day mortality among patients with hospital-acquired fungemia (HAF) in the Intensive Care Unit (ICU).MethodsA sub-analysis of a prospective, multicenter non-representative cohort study conducted in 162 ICUs in 24 countries.ResultsOf the 1156 patients with hospital-acquired bloodstream infections (HA-BSI) included in the EUROBACT study, 96 patients had a HAF. Median time to its diagnosis was 20 days (IQR 10.5–30.5) and 9 days (IQR 3–15.5) after hospital and ICU admission, respectively. Median time to positivity of blood culture was longer in fungemia than in bacteremia (48.7 h vs. 38.1 h; p = 0.0004). Candida albicans was the most frequent fungus isolated (57.1 %), followed by Candida glabrata (15.3 %) and Candida parapsilosis (10.2 %). No clear source of HAF was detected in 33.3 % of the episodes and it was catheter-related in 21.9 % of them. Compared to patients with bacteremia, HAF patients had a higher rate of septic shock (39.6 % vs. 21.6 %; p = 0.0003) and renal dysfunction (25 % vs. 12.4 %; p = 0.0023) on admission and a higher rate of renal failure (26 % vs. 16.2 %; p = 0.0273) at diagnosis. Adequate treatment started within 24 h after blood culture collection was less frequent in HAF patients (22.9 % vs. 55.3 %; p < 0.001). The 28-day all cause fatality was 40.6 %. According to multivariate analysis, only liver failure (OR 14.35; 95 % CI 1.17–175.6; p = 0.037), need for mechanical ventilation (OR 8.86; 95 % CI 1.2–65.24; p = 0.032) and ICU admission for medical reason (OR 3.87; 95 % CI 1.25–11.99; p = 0.020) were independent predictors of 28-day mortality in HAF patients.ConclusionsFungi are an important cause of hospital-acquired BSI in the ICU. Patients with HAF present more frequently with septic shock and renal dysfunction on ICU admission and have a higher rate of renal failure at diagnosis. HAF are associated with a significant 28-day mortality rate (40 %), but delayed adequate antifungal therapy was not an independent risk factor for death. Liver failure, need for mechanical ventilation and ICU admission for medical reason were the only independent predictors of 28-day mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1229-1) contains supplementary material, which is available to authorized users.
Highlights
To characterize and identify prognostic factors for 28-day mortality among patients with hospitalacquired fungemia (HAF) in the Intensive Care Unit (ICU)
Severity of illness was defined at ICU admission using the Simplified Acute Physiology Score (SAPS) II [20] and at HA-Bloodstream infection(s) (BSI) diagnosis using the Sequential Organ Failure Assessment (SOFA) score [21]
A fungus was recovered from the blood in 96 of the 1,156 patients (8.3 %) with hospital-acquired bloodstream infections (HA-BSI) admitted to an ICU, included in the EUROBACT study [7]
Summary
To characterize and identify prognostic factors for 28-day mortality among patients with hospitalacquired fungemia (HAF) in the Intensive Care Unit (ICU). Bloodstream infection(s) (BSI) in the critically ill patients are a major cause of morbidity and mortality. The prevalence varies between centers, representing 15 % of all nosocomial infections in a recent, large, multicenter prevalence study [1]. The prognosis of BSI varies, Fungi are responsible for around 20 % of all microbiologically documented infections in the Intensive Care Unit (ICU) [1]. The incidence of invasive fungal infections has increased steadily, namely due to the increasing number of both immunocompromised and critically ill patients. We faced a worldwide rise in the prevalence of candidemia, in the ICU [2,3,4,5,6].
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