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Risk factors for noncatheter-related Candida bloodstream infections in intensive care units: A multicenter
Ferhat Arslan1, Hulya Caskurlu1, Sema Sarı2
1Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
Abstract:
Candida bloodstream infections are associated with high mortality among critically ill patients in intensive care units (ICUs). Studies that explore the risk factors for candidemia may support better patient care in intensive care units. We conducted a retrospective, multicenter case-control study to investigate the risk factors for noncatheter-related Candida bloodstream infections (CBSI) in adult ICUs. Participants selected controls randomly on a 1:1 basis among all noncase patients stayed during the same period in ICUs. Data on 139 cases and 140 controls were deemed eligible. Among the controls, 69 patients died. The stratified Fine-Gray model was used to estimate the subdistribution Hazard ratios. The subdistribution hazards and 95% confidence intervals for final covariates were as follows: prior exposure to antimycotic agents, 2.21 (1.56-3.14); prior exposure to N-acetylcysteine, 0.11 (0.03-0.34) and prior surgical intervention, 1.26 (0.76-2.11). Of the patients, those exposed to antimycotic drugs, 87.1% (54/62) had breakthrough candidemia. Serious renal, hepatic, or hematologic side effects were comparable between patients those exposed and not-exposed to systemic antimycotic drugs. Untargeted administration of antimycotic drugs did not improve survival among candidemic patients (not-exposed, 63.6% [49/77]; exposed % 66.1 [41/62]; P = .899). This study documented that exposure to an antifungal agent is associated with increased the risk of subsequent development of CBSIs among nonneutropenic adult patients admitted to the ICU. Only two centers regularly prescribed N-acetylcysteine. Due to the limited number of subjects, we interpreted the positive effect of N-acetylcysteine on the absolute risk of CBSIs with caution.
Insights
Prior antifungal exposure increases the risk of Candida bloodstream infections (CBSI) in intensive care unit (ICU) patients. N-acetylcysteine showed a protective effect, though further research is needed due to limited data.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Background:
- Candida bloodstream infections (CBSI) are a significant cause of mortality in critically ill patients within intensive care units (ICUs).
- Identifying risk factors for CBSI is crucial for improving patient management in ICUs.
- Noncatheter-related CBSI presents a specific challenge in critical care settings.
Purpose of the Study:
- To investigate the risk factors associated with noncatheter-related Candida bloodstream infections (CBSI) in adult intensive care units (ICUs).
- To evaluate the impact of prior exposures, including antimycotic agents and N-acetylcysteine, on the development of CBSI.
- To analyze the association between antifungal exposure and breakthrough candidemia.
Main Methods:
- Retrospective, multicenter case-control study design.
- Inclusion of 139 cases and 140 controls from adult ICUs.
- Utilized the stratified Fine-Gray model to estimate subdistribution Hazard Ratios for various risk factors.
Main Results:
- Prior exposure to antimycotic agents was significantly associated with an increased risk of CBSI (Hazard Ratio: 2.21).
- Prior exposure to N-acetylcysteine showed a protective effect (Hazard Ratio: 0.11), although this finding requires cautious interpretation due to limited data.
- Prior surgical intervention was also associated with a higher risk (Hazard Ratio: 1.26).
- Antifungal drug exposure did not improve survival rates in candidemic patients.
Conclusions:
- Exposure to antifungal agents is a significant risk factor for developing Candida bloodstream infections in nonneutropenic adult ICU patients.
- N-acetylcysteine may play a protective role against CBSI, warranting further investigation.
- Current evidence does not support the untargeted administration of antimycotic drugs for improving survival in candidemic patients.
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