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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.
Critical Care (London, England)
|March 20, 2020
Summary
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.
