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Published on: July 1, 2020
Candidemia Surveillance and Impact on Non-neutropenic Critically Ill Patients
Lisa Hall Zimmerman1, Heather Dolman2,3, Janie Faris4
1Department of Pharmaceutical Services, William Beaumont University Hospital, Royal Oak, USA.
Background:
Candidemia is a common pathogen in critically ill patients and has a significant negative impact on morbidity and mortality. Risk factors linked with candidemia are reported in the literature. We evaluated the risk factors associated with candidemia in critically ill patients on mortality rates, including the impact of delayed or inadequate antifungal therapy (IAAT).
Methods:
This retrospective study evaluated non-neutropenic critically ill adult patients with candidemia for six consecutive years. Antifungal therapy was evaluated for the following: the correct dose based on the in vitro activity against Candida species identified on culture, the time interval from culture positivity to the initiation of antifungal therapy, and the duration of antifungal therapy. Adequate antifungal therapy (AAT) was defined as the initial antifungal agent administered to the patient with in vitro activity against Candida species identified on culture using the correct dose, time of initiation, and duration of therapy. IAAT was determined if the antifungal did not have in vitro activity against the Candida species identified on culture with the initial incorrect dose.
Results:
In the 91 critically ill patients evaluated with documented candidemia, the mean age was 57±16 years, the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 25±9, and the overall mortality rate was 38%. Patients with the following risk factors for candidemia had an increased mortality: use of mechanical ventilation (35 (100%), p<0.001), vasopressor therapy (28 (80%), p<0.001), end-stage renal disease (ESRD) (11 (31%), p<0.001), and ≥ 2 organ failure (23 (65%), p=0.002). Mortality was also more likely in patients who received IAAT: 16 (64%) IAAT vs. 19 (29%) AAT, p=0.001.
Conclusions:
In critically ill patients with risk factors associated with candidemia, AAT is important when candidemia is suspected. This study found that C. glabrata was more likely isolated in patients with ESRD, vasopressor therapy for hemodynamic support, high APACHE II scores, and ≥ 2 organ dysfunction.
Insights
Adequate antifungal therapy (AAT) is crucial for critically ill patients with candidemia. Inadequate antifungal therapy (IAAT) significantly increases mortality rates, highlighting the need for timely and appropriate treatment.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Clinical Microbiology
Background:
- Candidemia poses a significant threat to critically ill patients, increasing morbidity and mortality.
- Identifying risk factors for candidemia and its impact on outcomes is essential.
- The role of antifungal therapy appropriateness in patient survival requires further investigation.
Purpose of the Study:
- To evaluate risk factors associated with candidemia in critically ill patients.
- To assess the impact of delayed or inadequate antifungal therapy (IAAT) on mortality rates.
- To determine the association between specific risk factors and the incidence of *C. glabrata*.
Main Methods:
- Retrospective study of non-neutropenic critically ill adult patients with candidemia over six years.
- Evaluation of antifungal therapy for correct dosing, timely initiation, and appropriate duration based on *in vitro* susceptibility.
- Definition of Adequate Antifungal Therapy (AAT) and Inadequate Antifungal Therapy (IAAT) based on prescribed treatment and susceptibility results.
Main Results:
- Overall mortality rate was 38% in 91 evaluated patients with candidemia.
- Risk factors associated with increased mortality included mechanical ventilation, vasopressor therapy, end-stage renal disease (ESRD), and multiple organ failure.
- Patients receiving IAAT had significantly higher mortality (64%) compared to those receiving AAT (29%).
Conclusions:
- Adequate antifungal therapy (AAT) is critical for improving survival in critically ill patients with candidemia.
- Specific risk factors like ESRD and vasopressor use were linked to *Candida glabrata* isolation.
- Prompt and appropriate antifungal treatment is essential for managing candidemia in high-risk patient populations.
