Τίτλος:
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)
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Klingspor, L.
Tortorano, A.M.
Peman, J.
Willinger, B.
Hamal, P.
Sendid, B.
Velegraki, A.
Kibbler, C.
Meis, J.F.
Sabino, R.
Ruhnke, M.
Arikan-Akdagli, S.
Salonen, J.
Dóczi, I.
Περιοδικό:
Clinical Microbiology and Infection
Λέξεις-κλειδιά:
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
DOI:
10.1016/j.cmi.2014.08.011
