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Updated: Dec 26, 2025
An Ex vivo Assay to Study Candida albicans Hyphal Morphogenesis in the Gastrointestinal Tract
Published on: July 1, 2020
Risk factors for candidemia: a prospective matched case-control study
Julien Poissy1,2,3, Lauro Damonti3,4, Anne Bignon5
1Current affiliation : Univ. Lille, Inserm U1285, CHU Lille, Pôle de réanimation, NRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, F-59000, Lille, France.
Background:
Candidemia is an opportunistic infection associated with high morbidity and mortality in patients hospitalized both inside and outside intensive care units (ICUs). Identification of patients at risk is crucial to ensure prompt antifungal therapy. We sought to assess risk factors for candidemia and death, both outside and inside ICUs.
Methods:
This prospective multicenter matched case-control study involved six teaching hospitals in Switzerland and France. Cases were defined by positive blood cultures for Candida sp. Controls were matched to cases using the following criteria: age, hospitalization ward, hospitalization duration, and, when applicable, type of surgery. One to three controls were enrolled by case. Risk factors were analyzed by univariate and multivariate conditional regression models, as a basis for a new scoring system to predict candidemia.
Results:
One hundred ninety-two candidemic patients and 411 matched controls were included. Forty-four percent of included patients were hospitalized in ICUs, and 56% were hospitalized outside ICUs. Independent risk factors for candidemia in the ICU population included total parenteral nutrition, acute kidney injury, heart disease, prior septic shock, and exposure to aminoglycoside antibiotics. Independent risk factors for candidemia in the non-ICU population included central venous catheter, total parenteral nutrition, and exposure to glycopeptides and nitroimidazoles. The accuracy of the scores based on these risk factors is better in the ICU than in the non-ICU population. Independent risk factors for death in candidemic patients included septic shock, acute kidney injury, and the number of antibiotics to which patients were exposed before candidemia.
Discussion:
While this study shows a role for known and novel risk factors for candidemia, it specifically highlights important differences in their distribution according to the hospital setting (ICU versus non-ICU).
Conclusion:
This study provides novel risk scores for candidemia accounting for the hospital setting and recent progress in patients' management strategies and fungal epidemiology.
Insights
Identifying risk factors for candidemia (Candida bloodstream infections) is key for prompt treatment. This study developed new risk scores, showing different factors for intensive care unit (ICU) versus non-ICU patients.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Candidemia presents a significant threat, causing high morbidity and mortality in hospitalized patients.
- Prompt identification of at-risk individuals is essential for timely antifungal therapy.
- Understanding risk factors is crucial for both intensive care unit (ICU) and non-ICU settings.
Purpose of the Study:
- To assess risk factors associated with candidemia (Candida bloodstream infections) and mortality.
- To develop a novel scoring system for predicting candidemia based on identified risk factors.
- To differentiate risk factors between ICU and non-ICU patient populations.
Main Methods:
- A prospective, multicenter, matched case-control study was conducted across six teaching hospitals in Switzerland and France.
- Cases were patients with positive blood cultures for Candida species; controls were matched by age, ward, and hospitalization duration.
- Risk factors were analyzed using univariate and multivariate conditional regression models.
Main Results:
- 192 candidemic patients and 411 controls were analyzed, with 44% in ICUs and 56% outside.
- ICU risk factors included total parenteral nutrition, acute kidney injury, heart disease, septic shock, and aminoglycoside exposure.
- Non-ICU risk factors included central venous catheters, total parenteral nutrition, glycopeptide, and nitroimidazole exposure.
- Risk factors for death in candidemic patients were septic shock, acute kidney injury, and broad-spectrum antibiotic exposure.
Conclusions:
- This study identified distinct risk factors for candidemia in ICU versus non-ICU settings.
- Novel risk scores were developed, improving prediction accuracy by considering the hospital setting.
- Findings highlight the importance of tailored risk assessment and management strategies for candidemia.
