Abstract
BackgroundIn the context of recent guidelines on invasive candidiasis (IC), how French intensive care units (ICUs) are managing IC?MethodsThis is a prospective observational multicenter cohort study. During 1 year (2012–2013), 87 French ICUs enrolled consecutive patients with suspected or proven IC (SIC or PIC) and receiving systemic antifungal therapy (SAT). Data were collected up to 28 days after inclusion.ResultsWe studied 835 patients, 291 with PIC and 544 with SIC. At SAT initiation, patients with SIC were significantly more severe (SAPS II 50.1 ± 18.7 vs. 46.2 ± 18.0). Severe sepsis or septic shock prompted to initiate empiric SAT in 70 % of SIC. Within 4 days in median, the initial SAT was modified in 49 % of patients with PIC vs. 33 % patients with SIC. Modifications were most often motivated by mycological results, and de-escalation was the most frequent change. Regarding compliance to IC management guidelines, echinocandin was used for 182 (62.5 %) patients with PIC, and 287 (52.7 %) of those with SIC; central venous catheter was removed in 87 (54.3 %) of patients with candidaemia, and 43 of the remaining patients received echinocandin; and de-escalation was undertaken after 5 days of SAT in 142 patients, after 10 days in 13 patients. As 20.6 % of SIC were secondarily documented, 403/835 (48 %) patients had finally a proven IC. Candida albicans was the main pathogen (65.3 %), then Candida glabrata (15.9 %). The 28-day mortality rates were 40.0 % in candidaemia, 25.4 % in cIAI, and 26.7 % in deep-seated candidiasis. In the overall population of patients with proven IC, four independent prognostic factors were identified: immunosuppression (Odds Ratio (OR) = 1.977: 1.03–3.794 95 % confidence interval (CI), p = 0.04), age (OR = 1.035; 1.017–1.053 95 % CI; p < 0.001), SAPS >46 on ICU admission (OR = 2.894; 1.81–4.626 95 % CI; p < 0.001), and surgery just before or during ICU stay (OR = 0.473; 0.29–0.77 95 % CI; p < 0.001).ConclusionWhen SAT is initiated in French ICUs, the IC is ultimately proven for 48 % of patients. Empiric SAT is initiated in severely ill ICU patients. The initial SAT is often adapted, with de-escalation to fluconazole when possible. Mortality rate remains high.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-015-0103-7) contains supplementary material, which is available to authorized users.
Highlights
In the context of recent guidelines on invasive candidiasis (IC), how French intensive care units (ICUs) are managing IC?
The secondary objectives included the analysis of the Candida species involved in the IC, and of the patient outcome according to the final IC diagnosis, and of prognostic factors associated with mortality of the overall population of patients with a definite diagnosis of IC
We studied 835 patients, 291 with proven invasive candidiasis (PIC) when systemic antifungal therapy (SAT) was started and 544 for whom SAT was started for suspected invasive candidiasis (SIC)
Summary
In the context of recent guidelines on invasive candidiasis (IC), how French intensive care units (ICUs) are managing IC?. The management of critically ill patients in intensive care units (ICUs) has improved during the last decades yielding increased survival of patients with complex medical. Leroy et al Ann. Intensive Care (2016) 6:2 mortality rate of IC remains high. In the EPIC II study, mortality rate of candidaemia was 42.6 % [2]. While some studies showed a delayed administration of systemic antifungal therapy (SAT) was associated with increased mortality [10,11,12], others did not found any relationship between prognosis and the timing of initial therapy [13, 14]. Some scores based on risk factors-based predictions have been set to help clinicians [16,17,18]; their positive predictive value remains insufficient
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
