Risk Factors for Candidemia in Critically Ill Patients: A Systematic Review and Meta-Analysis

Abstract

Background: To assess the risk factors for candidemia as well as for non-albicans Candida (NAC) infections compared with Candida albicans infections in critically ill patients. Methods: MEDLINE, EMBASE, EBSCOhost, Web of Science and the Cochrane Library were systematically searched on June 2019. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the random effects generic inverse variance method. Results: Thirty studies with 259455 patients were included. The following factors were associated with candidemia in ICUs: sepsis [OR 5.03 (3.36-7.52)], acute renal failure [OR 3.70 (1.10-12.43)], Candida colonization [OR 3.49 (2.02-6.04)], neutropenia [OR 3.33 (2.54-4.38)], abdominal surgery [OR 2.81 (2.10-3.76)], hematological neoplasm [OR 2.49 (1.60-3.86)], malignancy [OR 1.80 (1.35-2.40)], chronic renal failure [OR 1.56 (1.01-2.43)], diabetes [OR 1.50 (1.14-1.99)], renal replacement therapy [OR 4.55 (2.90-7.15)], parenteral nutrition [OR 3.58 (1.88-6.80)], central venous catheters [OR 3.53 (2.28-5.45)], mechanical ventilation [OR 3.26 (1.79-5.95)], the use of broad-spectrum antibiotics [OR 3.12 (1.91-5.10)], antifungul drugs [OR 2.78 (1.51-5.12)] and steroids [OR 1.69 (1.24-2.30)]. Moreover, Neutropenia [OR 2.55 (1.33-4.91)], hematological neoplasm [OR 1.92 (1.03-3.55)]; malignancy [OR 1.67 (1.12-2.49)], the use of antifungul drugs [OR 2.34 (1.33-4.12)] and steroids [OR 1.90 (1.15-3.14)] were associated with a significantly higher risk of NAC infection than of C. albicans infection. Conclusions: This meta-analysis confirmed that sepsis, acute renal failure, Candida colonization, neutropenia, abdominal surgery, hematological neoplasm, malignancy, chronic renal failure, diabetes, renal replacement therapy, parenteral nutrition, central venous catheters, mechanical ventilation, the use of broad-spectrum antibiotics, antifungul drugs and steroids significantly increase the incidence of candidemia. Systematic review registration: PROSPERO registration number CRD42019122815. Funding: This project was funded by the National Natural Science Foundation of China (No.81571871 and 81770276), Nn10 program, Distinguished Young Scholars Fund of Harbin Medical University Cancer Hospital, the Yuweihan Fund for Distinguished Young Scholars of Harbin Medical University, Harbin Science and Technology Innovation Scholar Fund (2017RAXXJ087), Heilongjiang Province Postdoctoral Research Fund. Declaration of Interest: All authors declare they have no competing financial interests.