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Septic Shock Due to Candidemia: Outcomes and Predictors of Shock Development

BACKGROUND: The present report describes the outcomes of a cohort of patients with Candida induced septic shock. METHODS: Retrospective analysis of individuals who had at least one positive blood culture for Candida species ≥ 48 h after ICU admission. Data from patients that developed septic shock w...

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Autores principales: Guzman, Jorge A, Tchokonte, Ronny, Sobel, Jack D
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elmer Press 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140925/
https://www.ncbi.nlm.nih.gov/pubmed/21811532
http://dx.doi.org/10.4021/jocmr536w
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author Guzman, Jorge A
Tchokonte, Ronny
Sobel, Jack D
author_facet Guzman, Jorge A
Tchokonte, Ronny
Sobel, Jack D
author_sort Guzman, Jorge A
collection PubMed
description BACKGROUND: The present report describes the outcomes of a cohort of patients with Candida induced septic shock. METHODS: Retrospective analysis of individuals who had at least one positive blood culture for Candida species ≥ 48 h after ICU admission. Data from patients that developed septic shock within 48 hr of the positive blood culture were compared to non-shock candidemic patients. Patients with a concomitant bacteremia and/or endocarditis were excluded. RESULTS: Fifteen patients with Candida induced septic shock were studied and compared to 35 candidemic patients without shock. Overall mortality was 76% (87 % among those who had shock). A high proportion of non-albicans Candida species causing fungemia (74%) was observed. All patients with shock were receiving antibiotics but not antifungal treatment at the time of shock development, eight were on parenteral nutrition, six on steroids and nine had a cancer history. High dose fluconazole was the most common initial treatment provided. Four patients died before receiving any antifungal treatment. Time in ICU before the development of candidemia was identified as a predictor of shock development (higher chance if fungemia developed < 7 days after ICU admission). CONCLUSIONS: Septic shock due to invasive candidiasis is a near fatal condition. No conventional risk factors were identified to predict shock development other than time (shorter) spent in ICU before the development of candidemia. We encourage clinicians to consider the initiation of appropriate empiric antifungal treatment in high-risk patients who develop septic shock while on antimicrobial treatment. KEYWORDS: Septic shock; Candidemia; Outcome; Predictor
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spelling pubmed-31409252011-08-02 Septic Shock Due to Candidemia: Outcomes and Predictors of Shock Development Guzman, Jorge A Tchokonte, Ronny Sobel, Jack D J Clin Med Res Original Article BACKGROUND: The present report describes the outcomes of a cohort of patients with Candida induced septic shock. METHODS: Retrospective analysis of individuals who had at least one positive blood culture for Candida species ≥ 48 h after ICU admission. Data from patients that developed septic shock within 48 hr of the positive blood culture were compared to non-shock candidemic patients. Patients with a concomitant bacteremia and/or endocarditis were excluded. RESULTS: Fifteen patients with Candida induced septic shock were studied and compared to 35 candidemic patients without shock. Overall mortality was 76% (87 % among those who had shock). A high proportion of non-albicans Candida species causing fungemia (74%) was observed. All patients with shock were receiving antibiotics but not antifungal treatment at the time of shock development, eight were on parenteral nutrition, six on steroids and nine had a cancer history. High dose fluconazole was the most common initial treatment provided. Four patients died before receiving any antifungal treatment. Time in ICU before the development of candidemia was identified as a predictor of shock development (higher chance if fungemia developed < 7 days after ICU admission). CONCLUSIONS: Septic shock due to invasive candidiasis is a near fatal condition. No conventional risk factors were identified to predict shock development other than time (shorter) spent in ICU before the development of candidemia. We encourage clinicians to consider the initiation of appropriate empiric antifungal treatment in high-risk patients who develop septic shock while on antimicrobial treatment. KEYWORDS: Septic shock; Candidemia; Outcome; Predictor Elmer Press 2011-04 2011-04-04 /pmc/articles/PMC3140925/ /pubmed/21811532 http://dx.doi.org/10.4021/jocmr536w Text en Copyright © 2011, Guzman et al. http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Guzman, Jorge A
Tchokonte, Ronny
Sobel, Jack D
Septic Shock Due to Candidemia: Outcomes and Predictors of Shock Development
title Septic Shock Due to Candidemia: Outcomes and Predictors of Shock Development
title_full Septic Shock Due to Candidemia: Outcomes and Predictors of Shock Development
title_fullStr Septic Shock Due to Candidemia: Outcomes and Predictors of Shock Development
title_full_unstemmed Septic Shock Due to Candidemia: Outcomes and Predictors of Shock Development
title_short Septic Shock Due to Candidemia: Outcomes and Predictors of Shock Development
title_sort septic shock due to candidemia: outcomes and predictors of shock development
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140925/
https://www.ncbi.nlm.nih.gov/pubmed/21811532
http://dx.doi.org/10.4021/jocmr536w
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