Candidemia Surveillance and Impact on Non-neutropenic Critically Ill Patients.

BACKGROUND

Candidemia is a common pathogen in critically ill patients and has a significant negative impact on morbidity and mortality. Risk factors linked with candidemia are reported in the literature. We evaluated the risk factors associated with candidemia in critically ill patients on mortality rates, including the impact of delayed or inadequate antifungal therapy (IAAT).

METHODS

This retrospective study evaluated non-neutropenic critically ill adult patients with candidemia for six consecutive years. Antifungal therapy was evaluated for the following: the correct dose based on the activity against species identified on culture, the time interval from culture positivity to the initiation of antifungal therapy, and the duration of antifungal therapy. Adequate antifungal therapy (AAT) was defined as the initial antifungal agent administered to the patient with activity against species identified on culture using the correct dose, time of initiation, and duration of therapy. IAAT was determined if the antifungal did not have activity against the  species identified on culture with the initial incorrect dose.

RESULTS

In the 91 critically ill patients evaluated with documented candidemia, the mean age was 57±16 years, the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 25±9, and the overall mortality rate was 38%. Patients with the following risk factors for candidemia had an increased mortality: use of mechanical ventilation (35 (100%), p<0.001), vasopressor therapy (28 (80%), p<0.001), end-stage renal disease (ESRD) (11 (31%), p<0.001), and ≥ 2 organ failure (23 (65%), p=0.002). Mortality was also more likely in patients who received IAAT: 16 (64%) IAAT vs. 19 (29%) AAT, p=0.001.

CONCLUSIONS

In critically ill patients with risk factors associated with candidemia, AAT is important when candidemia is suspected. This study found that  was more likely isolated in patients with ESRD, vasopressor therapy for hemodynamic support, high APACHE II scores, and ≥ 2 organ dysfunction.