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Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002–2010)

PURPOSE: To analyze trends in incidence and mortality of candidemia in intensive care units (ICUs) vs. non-ICU hospitalized patients and to determine risk factors for infection by specific species and for death. METHODS: Active hospital-based surveillance program of incident episodes of candidemia d...

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Autores principales: Lortholary, Olivier, Renaudat, Charlotte, Sitbon, Karine, Madec, Yoann, Denoeud-Ndam, Lise, Wolff, Michel, Fontanet, Arnaud, Bretagne, Stéphane, Dromer, Françoise
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147247/
https://www.ncbi.nlm.nih.gov/pubmed/25097069
http://dx.doi.org/10.1007/s00134-014-3408-3
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author Lortholary, Olivier
Renaudat, Charlotte
Sitbon, Karine
Madec, Yoann
Denoeud-Ndam, Lise
Wolff, Michel
Fontanet, Arnaud
Bretagne, Stéphane
Dromer, Françoise
author_facet Lortholary, Olivier
Renaudat, Charlotte
Sitbon, Karine
Madec, Yoann
Denoeud-Ndam, Lise
Wolff, Michel
Fontanet, Arnaud
Bretagne, Stéphane
Dromer, Françoise
author_sort Lortholary, Olivier
collection PubMed
description PURPOSE: To analyze trends in incidence and mortality of candidemia in intensive care units (ICUs) vs. non-ICU hospitalized patients and to determine risk factors for infection by specific species and for death. METHODS: Active hospital-based surveillance program of incident episodes of candidemia due to common species in 24 tertiary care hospitals in the Paris area, France between October 2002 and September 2010. RESULTS: Among 2,507 adult cases included, 2,571 Candida isolates were collected and species were C. albicans (56 %), C. glabrata (18.6 %), C. parapsilosis (11.5 %), C. tropicalis (9.3 %), C. krusei (2.9 %), and C. kefyr (1.8 %). Candidemia occurred in ICU in 1,206 patients (48.1 %). When comparing ICU vs. non-ICU patients, the former had significantly more frequent surgery during the past 30 days, were more often preexposed to fluconazole and treated with echinocandin, and were less frequently infected with C. parapsilosis. Risk factors and age remained unchanged during the study period. A significant increased incidence in the overall population and ICU was found. The odds of being infected with a given species in ICU was influenced by risk factors and preexposure to fluconazole and caspofungin. Echinocandins initial therapy increased over time in ICU (4.6 % first year of study, to 48.5 % last year of study, p < 0.0001). ICU patients had a higher day-30 death rate than non-ICU patients (odds ratio [OR] 2.12; 95 % confidence interval [CI] 1.66–2.72; p < 0.0001). The day-30 and early (<day 8) death rates increased over time in ICU (from 41.5 % the first to 56.9 % the last year of study (p = 0.001) and 28.7–38.8 % (p = 0.0292), respectively). Independent risk factors for day-30 death in ICU were age, arterial catheter, Candida species, preexposure to caspofungin, and lack of antifungal therapy at the time of blood cultures results (p < 0.05). CONCLUSIONS: The availability of new antifungals and the publication of numerous guidelines did not prevent an increase of candidemia and death in ICU patients in the Paris area.
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spelling pubmed-41472472014-08-28 Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002–2010) Lortholary, Olivier Renaudat, Charlotte Sitbon, Karine Madec, Yoann Denoeud-Ndam, Lise Wolff, Michel Fontanet, Arnaud Bretagne, Stéphane Dromer, Françoise Intensive Care Med Original PURPOSE: To analyze trends in incidence and mortality of candidemia in intensive care units (ICUs) vs. non-ICU hospitalized patients and to determine risk factors for infection by specific species and for death. METHODS: Active hospital-based surveillance program of incident episodes of candidemia due to common species in 24 tertiary care hospitals in the Paris area, France between October 2002 and September 2010. RESULTS: Among 2,507 adult cases included, 2,571 Candida isolates were collected and species were C. albicans (56 %), C. glabrata (18.6 %), C. parapsilosis (11.5 %), C. tropicalis (9.3 %), C. krusei (2.9 %), and C. kefyr (1.8 %). Candidemia occurred in ICU in 1,206 patients (48.1 %). When comparing ICU vs. non-ICU patients, the former had significantly more frequent surgery during the past 30 days, were more often preexposed to fluconazole and treated with echinocandin, and were less frequently infected with C. parapsilosis. Risk factors and age remained unchanged during the study period. A significant increased incidence in the overall population and ICU was found. The odds of being infected with a given species in ICU was influenced by risk factors and preexposure to fluconazole and caspofungin. Echinocandins initial therapy increased over time in ICU (4.6 % first year of study, to 48.5 % last year of study, p < 0.0001). ICU patients had a higher day-30 death rate than non-ICU patients (odds ratio [OR] 2.12; 95 % confidence interval [CI] 1.66–2.72; p < 0.0001). The day-30 and early (<day 8) death rates increased over time in ICU (from 41.5 % the first to 56.9 % the last year of study (p = 0.001) and 28.7–38.8 % (p = 0.0292), respectively). Independent risk factors for day-30 death in ICU were age, arterial catheter, Candida species, preexposure to caspofungin, and lack of antifungal therapy at the time of blood cultures results (p < 0.05). CONCLUSIONS: The availability of new antifungals and the publication of numerous guidelines did not prevent an increase of candidemia and death in ICU patients in the Paris area. Springer Berlin Heidelberg 2014-08-06 2014 /pmc/articles/PMC4147247/ /pubmed/25097069 http://dx.doi.org/10.1007/s00134-014-3408-3 Text en © The Author(s) 2014 https://creativecommons.org/licenses/by-nc/4.0/ Open AccessThis article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
spellingShingle Original
Lortholary, Olivier
Renaudat, Charlotte
Sitbon, Karine
Madec, Yoann
Denoeud-Ndam, Lise
Wolff, Michel
Fontanet, Arnaud
Bretagne, Stéphane
Dromer, Françoise
Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002–2010)
title Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002–2010)
title_full Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002–2010)
title_fullStr Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002–2010)
title_full_unstemmed Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002–2010)
title_short Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002–2010)
title_sort worrisome trends in incidence and mortality of candidemia in intensive care units (paris area, 2002–2010)
topic Original
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147247/
https://www.ncbi.nlm.nih.gov/pubmed/25097069
http://dx.doi.org/10.1007/s00134-014-3408-3
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