Publication
Risk factors for candidemia: a prospective matched case-control study
Journal Paper/Review - Mar 18, 2020
Poissy Julien, Calandra Thierry, Sendid Boualem, Poulain Daniel, Van Delden Christian, Lamoth Frédéric, Marchetti Oscar, Bochud Pierre-Yves, FUNGINOS, Pagani Jean-Luc, Zimmerli Stephan, Artru Florent, Damonti Lauro, Bignon Anne, Khanna Nina, von Kietzell Matthias, Boggian Katia, Neofytos Dionysios, Vuotto Fanny, Coiteux Valérie, Allfun French Study Groups
Units
PubMed
Doi
Citation
Type
Journal
Publication Date
Issn Electronic
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Brief description/objective
BACKGROUND
Candidemia is an opportunistic infection associated with high morbidity and mortality in patients hospitalized both inside and outside intensive care units (ICUs). Identification of patients at risk is crucial to ensure prompt antifungal therapy. We sought to assess risk factors for candidemia and death, both outside and inside ICUs.
METHODS
This prospective multicenter matched case-control study involved six teaching hospitals in Switzerland and France. Cases were defined by positive blood cultures for Candida sp. Controls were matched to cases using the following criteria: age, hospitalization ward, hospitalization duration, and, when applicable, type of surgery. One to three controls were enrolled by case. Risk factors were analyzed by univariate and multivariate conditional regression models, as a basis for a new scoring system to predict candidemia.
RESULTS
One hundred ninety-two candidemic patients and 411 matched controls were included. Forty-four percent of included patients were hospitalized in ICUs, and 56% were hospitalized outside ICUs. Independent risk factors for candidemia in the ICU population included total parenteral nutrition, acute kidney injury, heart disease, prior septic shock, and exposure to aminoglycoside antibiotics. Independent risk factors for candidemia in the non-ICU population included central venous catheter, total parenteral nutrition, and exposure to glycopeptides and nitroimidazoles. The accuracy of the scores based on these risk factors is better in the ICU than in the non-ICU population. Independent risk factors for death in candidemic patients included septic shock, acute kidney injury, and the number of antibiotics to which patients were exposed before candidemia.
DISCUSSION
While this study shows a role for known and novel risk factors for candidemia, it specifically highlights important differences in their distribution according to the hospital setting (ICU versus non-ICU).
CONCLUSION
This study provides novel risk scores for candidemia accounting for the hospital setting and recent progress in patients' management strategies and fungal epidemiology.