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 due...
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| Veröffentlicht in: | Intensive care medicine 2014-09, Vol.40 (9), p.1303-1312 |
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| creator | Lortholary, Olivier Renaudat, Charlotte Sitbon, Karine Madec, Yoann Denoeud-Ndam, Lise Wolff, Michel Fontanet, Arnaud Bretagne, Stéphane Dromer, Françoise |
| 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
|
| doi_str_mv | 10.1007/s00134-014-3408-3 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4147247</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A724301389</galeid><sourcerecordid>A724301389</sourcerecordid><originalsourceid>FETCH-LOGICAL-c782t-dcf41e827823338f18b2966b77664ba8f7f18e1d311f344f1df172678d4ffbd3</originalsourceid><addsrcrecordid>eNqNkt9q1EAUxoModq0-gDcS8KYFU-dfJpMbYSnVCgt6UfBymE3ObKcmM-tMstA738E39Ek8IbXtlgqSQJhzfucL55svy15TckIJqd4nQigXBaGi4IKogj_JFlRwVlDG1dNsQbhghZCCHWQvUrpCupIlfZ4dsJLUFZH1Ivv-LcToUughHyL4NuXO49u4FnwDufFt3oc4mM4N13mweYMV7PXOzOAAPrkdYD1CPno3pPzoq0HFHAvmXc4IYb9__mKEkuOX2TNrugSvbr6H2cXHs4vT82L15dPn0-WqaCrFhqJtrKCgGB4458pStWa1lOuqklKsjbIVloC2nFLLhbC0tbRislKtsHbd8sPswyy7Hdc9tA34IZpOb6PrTbzWwTi93_HuUm_CTgsqKiYqFChmgcsHY-fLld6aNMAYNZpOSibkjiJ_dPPDGH6MkAbdu9RA1xkPYUyallIqLin7H7RUJSOKl4i-fYBehTF6NG6iZM1LVdd31MZ0oJ23AVdqJlG9xGU4BkTVdxvtURvwgPsHD9ZheY8_eYTHZ7r55tEBOg80MaQUwd76RomesqrnrE626SmrmuPMm_v3dDvxN5wIsBlI2PIbiPcc-KfqH-eX8NM</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1556935899</pqid></control><display><type>article</type><title>Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002–2010)</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Lortholary, Olivier ; Renaudat, Charlotte ; Sitbon, Karine ; Madec, Yoann ; Denoeud-Ndam, Lise ; Wolff, Michel ; Fontanet, Arnaud ; Bretagne, Stéphane ; Dromer, Françoise</creator><creatorcontrib>Lortholary, Olivier ; Renaudat, Charlotte ; Sitbon, Karine ; Madec, Yoann ; Denoeud-Ndam, Lise ; Wolff, Michel ; Fontanet, Arnaud ; Bretagne, Stéphane ; Dromer, Françoise ; French Mycosis Study Group ; The French Mycosis Study Group</creatorcontrib><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.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-014-3408-3</identifier><identifier>PMID: 25097069</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Analysis ; Anesthesiology ; Antifungal Agents - therapeutic use ; Blood ; Candida ; Candidemia - drug therapy ; Candidemia - epidemiology ; Candidemia - mortality ; Caspofungin ; Critical Care Medicine ; Emergency Medicine ; Epidemiology ; Female ; Fluconazole ; France ; Health aspects ; Hematology ; Hospital patients ; Hospitalization ; Human health and pathology ; Humans ; Incidence ; Infection ; Infectious diseases ; Intensive ; Intensive care ; Intensive Care Units ; Life Sciences ; Male ; Medical examination ; Medicine ; Medicine & Public Health ; Microbiology and Parasitology ; Middle Aged ; Mortality ; Mycology ; Original ; Pain Medicine ; Paris - epidemiology ; Pediatrics ; Pneumology/Respiratory System ; Prospective Studies ; Risk Assessment ; Risk Factors ; Spain ; Surveillance ; Time Factors ; Trends</subject><ispartof>Intensive care medicine, 2014-09, Vol.40 (9), p.1303-1312</ispartof><rights>The Author(s) 2014</rights><rights>COPYRIGHT 2014 Springer</rights><rights>Springer-Verlag Berlin Heidelberg and ESICM 2014</rights><rights>Attribution - NonCommercial - ShareAlike</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c782t-dcf41e827823338f18b2966b77664ba8f7f18e1d311f344f1df172678d4ffbd3</citedby><cites>FETCH-LOGICAL-c782t-dcf41e827823338f18b2966b77664ba8f7f18e1d311f344f1df172678d4ffbd3</cites><orcidid>0000-0003-1671-1475 ; 0000-0002-6201-1261 ; 0000-0001-6870-3800</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00134-014-3408-3$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00134-014-3408-3$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25097069$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://pasteur.hal.science/pasteur-01405246$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Lortholary, Olivier</creatorcontrib><creatorcontrib>Renaudat, Charlotte</creatorcontrib><creatorcontrib>Sitbon, Karine</creatorcontrib><creatorcontrib>Madec, Yoann</creatorcontrib><creatorcontrib>Denoeud-Ndam, Lise</creatorcontrib><creatorcontrib>Wolff, Michel</creatorcontrib><creatorcontrib>Fontanet, Arnaud</creatorcontrib><creatorcontrib>Bretagne, Stéphane</creatorcontrib><creatorcontrib>Dromer, Françoise</creatorcontrib><creatorcontrib>French Mycosis Study Group</creatorcontrib><creatorcontrib>The French Mycosis Study Group</creatorcontrib><title>Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002–2010)</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><addtitle>Intensive Care Med</addtitle><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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis</subject><subject>Anesthesiology</subject><subject>Antifungal Agents - therapeutic use</subject><subject>Blood</subject><subject>Candida</subject><subject>Candidemia - drug therapy</subject><subject>Candidemia - epidemiology</subject><subject>Candidemia - mortality</subject><subject>Caspofungin</subject><subject>Critical Care Medicine</subject><subject>Emergency Medicine</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Fluconazole</subject><subject>France</subject><subject>Health aspects</subject><subject>Hematology</subject><subject>Hospital patients</subject><subject>Hospitalization</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infection</subject><subject>Infectious diseases</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Intensive Care Units</subject><subject>Life Sciences</subject><subject>Male</subject><subject>Medical examination</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Microbiology and Parasitology</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Mycology</subject><subject>Original</subject><subject>Pain Medicine</subject><subject>Paris - epidemiology</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Spain</subject><subject>Surveillance</subject><subject>Time Factors</subject><subject>Trends</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkt9q1EAUxoModq0-gDcS8KYFU-dfJpMbYSnVCgt6UfBymE3ObKcmM-tMstA738E39Ek8IbXtlgqSQJhzfucL55svy15TckIJqd4nQigXBaGi4IKogj_JFlRwVlDG1dNsQbhghZCCHWQvUrpCupIlfZ4dsJLUFZH1Ivv-LcToUughHyL4NuXO49u4FnwDufFt3oc4mM4N13mweYMV7PXOzOAAPrkdYD1CPno3pPzoq0HFHAvmXc4IYb9__mKEkuOX2TNrugSvbr6H2cXHs4vT82L15dPn0-WqaCrFhqJtrKCgGB4458pStWa1lOuqklKsjbIVloC2nFLLhbC0tbRislKtsHbd8sPswyy7Hdc9tA34IZpOb6PrTbzWwTi93_HuUm_CTgsqKiYqFChmgcsHY-fLld6aNMAYNZpOSibkjiJ_dPPDGH6MkAbdu9RA1xkPYUyallIqLin7H7RUJSOKl4i-fYBehTF6NG6iZM1LVdd31MZ0oJ23AVdqJlG9xGU4BkTVdxvtURvwgPsHD9ZheY8_eYTHZ7r55tEBOg80MaQUwd76RomesqrnrE626SmrmuPMm_v3dDvxN5wIsBlI2PIbiPcc-KfqH-eX8NM</recordid><startdate>20140901</startdate><enddate>20140901</enddate><creator>Lortholary, Olivier</creator><creator>Renaudat, Charlotte</creator><creator>Sitbon, Karine</creator><creator>Madec, Yoann</creator><creator>Denoeud-Ndam, Lise</creator><creator>Wolff, Michel</creator><creator>Fontanet, Arnaud</creator><creator>Bretagne, Stéphane</creator><creator>Dromer, Françoise</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><general>Springer Verlag</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>M7N</scope><scope>1XC</scope><scope>VOOES</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1671-1475</orcidid><orcidid>https://orcid.org/0000-0002-6201-1261</orcidid><orcidid>https://orcid.org/0000-0001-6870-3800</orcidid></search><sort><creationdate>20140901</creationdate><title>Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002–2010)</title><author>Lortholary, Olivier ; Renaudat, Charlotte ; Sitbon, Karine ; Madec, Yoann ; Denoeud-Ndam, Lise ; Wolff, Michel ; Fontanet, Arnaud ; Bretagne, Stéphane ; Dromer, Françoise</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c782t-dcf41e827823338f18b2966b77664ba8f7f18e1d311f344f1df172678d4ffbd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis</topic><topic>Anesthesiology</topic><topic>Antifungal Agents - therapeutic use</topic><topic>Blood</topic><topic>Candida</topic><topic>Candidemia - drug therapy</topic><topic>Candidemia - epidemiology</topic><topic>Candidemia - mortality</topic><topic>Caspofungin</topic><topic>Critical Care Medicine</topic><topic>Emergency Medicine</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Fluconazole</topic><topic>France</topic><topic>Health aspects</topic><topic>Hematology</topic><topic>Hospital patients</topic><topic>Hospitalization</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infection</topic><topic>Infectious diseases</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Intensive Care Units</topic><topic>Life Sciences</topic><topic>Male</topic><topic>Medical examination</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Microbiology and Parasitology</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Mycology</topic><topic>Original</topic><topic>Pain Medicine</topic><topic>Paris - epidemiology</topic><topic>Pediatrics</topic><topic>Pneumology/Respiratory System</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Spain</topic><topic>Surveillance</topic><topic>Time Factors</topic><topic>Trends</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lortholary, Olivier</creatorcontrib><creatorcontrib>Renaudat, Charlotte</creatorcontrib><creatorcontrib>Sitbon, Karine</creatorcontrib><creatorcontrib>Madec, Yoann</creatorcontrib><creatorcontrib>Denoeud-Ndam, Lise</creatorcontrib><creatorcontrib>Wolff, Michel</creatorcontrib><creatorcontrib>Fontanet, Arnaud</creatorcontrib><creatorcontrib>Bretagne, Stéphane</creatorcontrib><creatorcontrib>Dromer, Françoise</creatorcontrib><creatorcontrib>French Mycosis Study Group</creatorcontrib><creatorcontrib>The French Mycosis Study Group</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lortholary, Olivier</au><au>Renaudat, Charlotte</au><au>Sitbon, Karine</au><au>Madec, Yoann</au><au>Denoeud-Ndam, Lise</au><au>Wolff, Michel</au><au>Fontanet, Arnaud</au><au>Bretagne, Stéphane</au><au>Dromer, Françoise</au><aucorp>French Mycosis Study Group</aucorp><aucorp>The French Mycosis Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002–2010)</atitle><jtitle>Intensive care medicine</jtitle><stitle>Intensive Care Med</stitle><addtitle>Intensive Care Med</addtitle><date>2014-09-01</date><risdate>2014</risdate><volume>40</volume><issue>9</issue><spage>1303</spage><epage>1312</epage><pages>1303-1312</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><abstract>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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>25097069</pmid><doi>10.1007/s00134-014-3408-3</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-1671-1475</orcidid><orcidid>https://orcid.org/0000-0002-6201-1261</orcidid><orcidid>https://orcid.org/0000-0001-6870-3800</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0342-4642 |
| ispartof | Intensive care medicine, 2014-09, Vol.40 (9), p.1303-1312 |
| issn | 0342-4642 1432-1238 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4147247 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adult Aged Aged, 80 and over Analysis Anesthesiology Antifungal Agents - therapeutic use Blood Candida Candidemia - drug therapy Candidemia - epidemiology Candidemia - mortality Caspofungin Critical Care Medicine Emergency Medicine Epidemiology Female Fluconazole France Health aspects Hematology Hospital patients Hospitalization Human health and pathology Humans Incidence Infection Infectious diseases Intensive Intensive care Intensive Care Units Life Sciences Male Medical examination Medicine Medicine & Public Health Microbiology and Parasitology Middle Aged Mortality Mycology Original Pain Medicine Paris - epidemiology Pediatrics Pneumology/Respiratory System Prospective Studies Risk Assessment Risk Factors Spain Surveillance Time Factors Trends |
| title | Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002–2010) |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-31T22%3A02%3A35IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Worrisome%20trends%20in%20incidence%20and%20mortality%20of%20candidemia%20in%20intensive%20care%20units%20(Paris%20area,%202002%E2%80%932010)&rft.jtitle=Intensive%20care%20medicine&rft.au=Lortholary,%20Olivier&rft.aucorp=French%20Mycosis%20Study%20Group&rft.date=2014-09-01&rft.volume=40&rft.issue=9&rft.spage=1303&rft.epage=1312&rft.pages=1303-1312&rft.issn=0342-4642&rft.eissn=1432-1238&rft_id=info:doi/10.1007/s00134-014-3408-3&rft_dat=%3Cgale_pubme%3EA724301389%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1556935899&rft_id=info:pmid/25097069&rft_galeid=A724301389&rfr_iscdi=true |