@article{3110321,
    title = "Invasive Candida infections in surgical patients in intensive care units: A prospective, multicentre survey initiated by the European Confederation of Medical Mycology (ECMM) (2006-2008)",
    author = "Klingspor, L. and Tortorano, A.M. and Peman, J. and Willinger, B. and Hamal, P. and Sendid, B. and Velegraki, A. and Kibbler, C. and Meis, J.F. and Sabino, R. and Ruhnke, M. and Arikan-Akdagli, S. and Salonen, J. and Dóczi, I.",
    journal = "Clinical Microbiology and Infection",
    year = "2015",
    volume = "21",
    number = "1",
    pages = "87.e1-87.e10",
    publisher = "Elsevier B.V.",
    issn = "1198-743X",
    doi = "10.1016/j.cmi.2014.08.011",
    keywords = "amphotericin B lipid complex;  caspofungin;  corticosteroid;  voriconazole;  antifungal agent, abdominal surgery;  adult;  Article;  Candida glabrata;  Candida parapsilosis;  Candida tropicalis;  central venous catheter;  European;  female;  health care survey;  human;  intensive care unit;  invasive candidiasis;  major clinical study;  male;  mortality;  mucosa;  mycology;  outcome assessment;  priority journal;  prospective study;  questionnaire;  surgical patient;  adolescent;  aged;  antibiotic prophylaxis;  Candida;  Candidiasis, Invasive;  child;  clinical trial;  infant;  intensive care unit;  middle aged;  multicenter study;  newborn;  preschool child;  statistics and numerical data;  surgery;  very elderly;  young adult, Candida;  Candida albicans;  Candida glabrata;  Candida parapsilosis;  Candida tropicalis;  Issatchenkia orientalis, Adolescent;  Adult;  Aged;  Aged, 80 and over;  Antibiotic Prophylaxis;  Antifungal Agents;  Candida;  Candidiasis, Invasive;  Child;  Child, Preschool;  Female;  Humans;  Infant;  Infant, Newborn;  Intensive Care Units;  Male;  Middle Aged;  Prospective Studies;  Surgical Procedures, Operative;  Young Adult",
    abstract = "A prospective, observational, multicentre study of invasive candidosis (IC) in surgical patients in intensive care units (ICUs) was conducted from 2006 to 2008 in 72 ICUs in 14 European countries. A total of 779 patients (62.5% males, median age 63 years) with IC were included. The median rate of candidaemia was 9 per 1000 admissions. In 10.8% the infection was already present at the time of admission to ICU. Candida albicans accounted for 54% of the isolates, followed by Candida parapsilosis 18.5%, Candida glabrata 13.8%, Candida tropicalis 6%, Candida krusei 2.5%, and other species 5.3%. Infections due to C.krusei (57.9%) and C.glabrata (43.6%) had the highest crude mortality rate. The most common preceding surgery was abdominal (51.5%), followed by thoracic (20%) and neurosurgery (8.2%). Candida glabrata was more often isolated after abdominal surgery in patients ≥60 years, and C.parapsilosis was more often isolated in neurosurgery and multiple trauma patients as well as children ≤1 year of age. The most common first-line treatment was fluconazole (60%), followed by caspofungin (18.7%), liposomal amphotericin B (13%), voriconazole (4.8%) and other drugs (3.5%). Mortality in surgical patients with IC in ICU was 38.8%. Multivariate analysis showed that factors independently associated with mortality were: patient age ≥60 years (hazard ratio (HR) 1.9, p 0.001), central venous catheter (HR 1.8, p 0.05), corticosteroids (HR 1.5, p 0.03), not receiving systemic antifungal treatment for IC (HR 2.8, p <0.0001), and not removing intravascular lines (HR 1.6, p 0.02). © 2014 European Society of Clinical Microbiology and Infectious Diseases."
}