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Published on: July 1, 2020
Candidemia in immunocompromised and immunocompetent critically ill patients: a prospective comparative study
G Dimopoulos1, A Karabinis, G Samonis
1Department of Intensive Care Medicine, Medical School, University of Athens, Athens, Greece.
Summary
Immunocompromised (IC) critically ill patients with candidemia frequently had oropharyngeal and esophageal candidiasis, unlike nonimmunocompromised (NIC) patients. Both groups experienced high mortality rates from Candida bloodstream infections.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Mycology
Background:
- Candidemia, a serious bloodstream infection caused by Candida species, poses a significant threat to critically ill patients.
- Understanding the differences in risk factors, clinical presentation, and outcomes between immunocompromised (IC) and nonimmunocompromised (NIC) patients with candidemia is crucial for effective management.
Purpose of the Study:
- To compare the risk factors, clinical manifestations, and outcomes of candidemia in critically ill immunocompromised (IC) versus nonimmunocompromised (NIC) patients.
- To investigate the prevalence of oropharyngeal and esophageal candidiasis in conjunction with candidemia in these two patient groups.
Main Methods:
- A prospective study was conducted over two years in a medical-surgical intensive care unit (ICU).
- Patients who developed candidemia during their ICU stay were analyzed, excluding those already on antifungal therapy or with prior systemic fungal infections.
- Diagnostic methods included blood, urine, and stool cultures, as well as endoscopy/biopsy of the esophagus and examination/culture of oropharyngeal and esophageal lesions.
Main Results:
- Twenty-four patients with candidemia were analyzed (9 IC, 15 NIC).
- Total parenteral nutrition (100% vs 53%), oropharyngeal candidiasis (55.5% vs 6.5%), and esophageal candidiasis (44% vs 0%) were significantly more common in IC patients.
- Crude mortality was high in both groups: 78% for IC patients and 60% for NIC patients.
Conclusions:
- Oropharyngeal and esophageal candidiasis are frequently associated with candidemia in immunocompromised critically ill patients.
- In contrast, this association is rare in nonimmunocompromised critically ill patients with Candida bloodstream infections.
- Candidemia is associated with high mortality in both immunocompromised and nonimmunocompromised critically ill patients.
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