[Fungal colonization and/or infection in intensive care units. Multicenter study of 1,562 patients]

Our objective was to assess the frequency of fungal colonization and/or infection in critically ill patients admitted to intensive care units (ICUs) and to describe the characteristics and risk factors of those patients in whom fungi had been isolated.

Observational, multicenter study of patients admitted to 64 ICUs on March 23, June 22, and November 16, 1999. In these patients, the presence of fungi was investigated in some biological sample from the day of ICU admission to the day of assessment of fungal infection. Patients were classified as colonized or infected by fungi.

A total of 1,562 patients were included: 686 in the first period, 567 in the second, and 309 in the third, with a mean of 24.4 patients per ICU (range, 9-62). Fungi were isolated in 456 biological samples from 248 patients (15.9 patients per each series of 100 controlled patients): lung in 183 (40.1%) cases, urine in 90 (19.7%) cases, and oropharynx in 46 (10.1%) cases. Fungi were isolated in blood cultures in 17 (3.7%) patients. Candida albicans was the most frequently isolated fungal species in all sites (68.9%). Isolation of fungi allowed a diagnosis of fungal infection in 121 patients (fungal infection rate, 7.7 episodes per 100 patients admitted to the ICU). Individual risk factors for fungal infection were as follows: previous use of antimicrobials (OR=5.01; 95% CI, 1.77-14.2); mechanical ventilation (OR=3.45; 95% CI, 1.61-7.40); urgent surgical procedures (OR = 2.44; 95% CI, 1.59-3.74); solid neoplasm (OR=2.32; 95% CI, 1.29-4.19); use of corticosteroids (OR = 1.88; 95% CI, 1.18-2.99); and APACHE II score (OR=1.05; 95% CI, 1.02-1.07).

Fungi were isolated in 15.9% patients admitted to ICUs and they were the causative agents of infection in 7.7% of cases. Candida albicans predominated in all sites. Risk factors for fungal infection included previous use of antibiotics, mechanical ventilation, urgent surgery, solid tumor, use of corticosteroids, and intermediate severity of illness according to the APACHE II score.