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ICU-acquired candidaemia in France: Epidemiology and temporal trends, 2004-2013 - A study from the REA-RAISIN network
Olivier Baldesi1, Sébastien Bailly2, Stéphane Ruckly2
1Centre Hospitalier Intercommunal Aix-Pertuis, Aix en Provence, France.
Objective:
Candidaemia is a life-threatening infectious disease, associated with septic shock, multiple organ failure, and a high mortality rate. In France, reported data on the incidence of ICU-acquired candidaemia and the causative Candida species are scarce. The objective of this study was to determine temporal trends in epidemiology and risk factors of intensive care unit-acquired candidaemia (ICU-Cand) and ICU mortality among a very large population of ICU patients.
Method:
Demographics, patient risk factors, invasive device exposure and nosocomial infection in ICU patient were collected from 2004 to 2013 in a national network of 213 ICUs: REA-RAISIN. Incidence and risk factors for candidaemia and ICU mortality were assessed.
Results:
Out of 246,459 ICU patients, 851 developed an ICU-cand, representing 0.3 per 1000 patients-days. The incidence rose sharply over time. Candida albicans was the main species. The overall and ICU mortality was 52.4% in ICU-cand patients. The main risk factors of ICU-cand were length of stay, severity of illness and antimicrobial therapy at ICU admission, immune status and use of invasive procedure. ICU-cand was an independent risk factor of mortality (OR: 1.53; 95%CI [1.40-1.70]); in a sub-group analysis, independent effects on mortality were observed with C. albicans (OR: 1.45 [1.23-1.71]), Candida tropicalis (OR: 2.11 [1.31-3.39]) and "other" Candida species (OR: 1.64 [1.09-2.45]).
Conclusion:
ICU candidaemia ranked sixth among bloodstream infections, and its average annual incidence was 0.3 per 1000 patients days. Despite of new therapy and international recommendation, the incidence rose sharply during the study period, and ICU mortality remained high.
Insights
The incidence of intensive care unit-acquired candidaemia (ICU-Cand) in France rose sharply between 2004 and 2013, with a high mortality rate of 52.4%. Key risk factors included prolonged ICU stay and invasive procedures.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Candidaemia is a severe bloodstream infection with high mortality.
- Data on intensive care unit-acquired candidaemia (ICU-Cand) incidence and species in France are limited.
- Understanding trends and risk factors is crucial for patient outcomes.
Purpose of the Study:
- To determine temporal trends in the epidemiology of ICU-Cand in France.
- To identify risk factors associated with ICU-Cand and ICU mortality.
- To analyze causative Candida species over a decade.
Main Methods:
- A national network of 213 ICUs (REA-RAISIN) collected data from 2004 to 2013.
- Demographics, patient risk factors, and invasive device use were recorded.
- Incidence and risk factors for ICU-Cand and ICU mortality were assessed.
Main Results:
- 851 cases of ICU-Cand occurred among 246,459 patients (0.3 per 1000 patient-days).
- Incidence significantly increased over the study period.
- Candida albicans was the predominant species; overall ICU mortality was 52.4%.
- Risk factors included prolonged ICU stay, illness severity, antimicrobial therapy, immune status, and invasive procedures.
- ICU-Cand was an independent risk factor for mortality (OR 1.53), with specific Candida species also associated with increased mortality.
Conclusions:
- ICU-Cand incidence rose sharply in France from 2004-2013, despite updated therapies.
- Mortality associated with ICU-Cand remains high.
- Effective prevention and management strategies are critical.