Invasive Candidiasis in Critically Ill Patients: A Prospective Cohort Study in Two Tertiary Care Centers

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Mycology

Background:

• Invasive candidiasis is a significant concern in intensive care units (ICUs), presenting with varied epidemiology and outcomes.
• This study investigated the characteristics, management, and outcomes of invasive candidiasis across six ICUs in two tertiary care centers.

Purpose of the Study:

• To evaluate the epidemiology of invasive candidiasis in critically ill patients.
• To analyze patient characteristics, treatment strategies, and outcomes associated with invasive candidiasis.
• To identify predictors of non-albicans versus albicans infections and hospital mortality.

Main Methods:

• A prospective observational study involving adult patients diagnosed with invasive candidiasis in six ICUs over four years.
• Data collection included patient demographics, Candida species, treatment initiation, and outcomes.
• Multivariable logistic regression was used to determine predictors of infection type and mortality.

Main Results:

• Invasive candidiasis occurred in 162 patients (2.6 cases per 100 ICU admissions), with non-albicans species being most frequent.
• Antifungal therapy was initiated after culture results in 59.6% of cases; resistance to fluconazole was 27.9%.
• Hospital mortality was high at 58.6%, with renal replacement therapy and ICU admission reason as independent predictors.

Conclusions:

• Non-albicans Candida species are predominant in critically ill patients with invasive candidiasis, associated with high mortality.
• Delayed antifungal therapy initiation suggests low clinical suspicion.
• Effective management strategies are crucial given the high mortality rates.