Incidence and outcome of invasive candidiasis in intensive care units (ICUs) in Europe: results of the EUCANDICU project

Matteo Bassetti,Maddalena Peghin,Antonio Vena,Simon Dubler,Joost Wauters,Ana Marques ,Cristiano Alicino,Massimo Antonelli,Anna Maria Azzini ,José Luis García-Garmendia ,Alessia Carnelutti,Herbert D Spapen ,Cp Berg ,Maria Panagiota Almyroudi ,Clément Le Bihan ,Benoît Veber ,Bart Jan Kullberg,Ignacio Martín‐Loeches ,Roberto Luzzati,Manu L N G Malbrain ,Massimo Girardis,Filippo Ansaldi,Andrea Cortegiani,Mario Venditti,Enora Atchade,Daniele Roberto Giacobbe ,Jeroen Schouten,Alessio Mesini,Pierluigi Brugnaro,Mario Tumbarello,Václava Adámková ,Guillaume Voiriot,Stefano Ianniruberto,Jean‐François Timsit ,Silvia Corcione,Polychronis Tasioudis,Santi Maurizio Raineri,Riina Rautemaa‐Richardson ,Katrien Lagrou,Oliver A Cornely,Novella Carannante,José Artur Paiva ,Valentino Tisa,Maria Merelli,Cecilia Trucchi,George Dimοpoulos ,Philippe Montravers

doi:10.1186/s13054-019-2497-3

Abstract

BackgroundThe objective of this study was to assess the cumulative incidence of invasive candidiasis (IC) in intensive care units (ICUs) in Europe.MethodsA multinational, multicenter, retrospective study was conducted in 23 ICUs in 9 European countries, representing the first phase of the candidemia/intra-abdominal candidiasis in European ICU project (EUCANDICU).ResultsDuring the study period, 570 episodes of ICU-acquired IC were observed, with a cumulative incidence of 7.07 episodes per 1000 ICU admissions, with important between-center variability. Separated, non-mutually exclusive cumulative incidences of candidemia and IAC were 5.52 and 1.84 episodes per 1000 ICU admissions, respectively. Crude 30-day mortality was 42%. Age (odds ratio [OR] 1.04 per year, 95% CI 1.02–1.06, p < 0.001), severe hepatic failure (OR 3.25, 95% 1.31–8.08, p 0.011), SOFA score at the onset of IC (OR 1.11 per point, 95% CI 1.04–1.17, p 0.001), and septic shock (OR 2.12, 95% CI 1.24–3.63, p 0.006) were associated with increased 30-day mortality in a secondary, exploratory analysis.ConclusionsThe cumulative incidence of IC in 23 European ICUs was 7.07 episodes per 1000 ICU admissions. Future in-depth analyses will allow explaining part of the observed between-center variability, with the ultimate aim of helping to improve local infection control and antifungal stewardship projects and interventions.

Highlights

The objective of this study was to assess the cumulative incidence of invasive candidiasis (IC) in intensive care units (ICUs) in Europe
Secondary objectives were (i) to assess the independent impact of center-level factors on the cumulative incidence of ICU-acquired IC and (ii) to assess factors associated with crude 30-day mortality in patients with ICU-acquired IC
The entire EUCANDICU project consists of two phases: (i) a first study describing the cumulative incidence of ICU-acquired IC in Europe, reported in the present paper; (ii) a second, case-control study to assess patient-level predictors of ICU-acquired IC, which will be conducted and published subsequently

Summary

Introduction

The objective of this study was to assess the cumulative incidence of invasive candidiasis (IC) in intensive care units (ICUs) in Europe. In the last 10 years, other series addressed the cumulative incidence of IC in the ICU setting [6,7,8,9,10]. The majority of those studies was limited to candidemia, some were limited to one or a few countries, and some occasionally included cases not representing true infections but colonization [6,7,8,9,10].

Objectives

Methods

Results

Discussion

Conclusion