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Risk factors and predictors of mortality of candidaemia among critically ill patients: role of antifungal prophylaxis in its development and in selection of non-albicans species

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Abstract

Purpose

The aim of the present study is to identify risk factors for development and predictors of mortality of candidaemia among critically ill patients.

Methods

A 1:7 case–control study was conducted during a 4-year period (2012–2015) in a Greek Intensive Care Unit (ICU). Candidaemia was confirmed by positive blood cultures. All yeasts were identified using API 20C AUX System or Vitek 2 Advanced Expert System. Epidemiologic data were collected from the ICU computerized database and patients’ chart reviews.

Results

Fifty-three patients developed candidaemia with non-albicans species being the predominant ones (33 patients, 62.3%). Multivariate analysis found that prior emergency surgery, malignancy, hospitalization during summer months, prior septic shock by KPC-producing Klebsiella pneumoniae and number of antibiotics administered were independently associated with candidaemia, while, prior administration of azole was a protective factor. Non-albicans candidaemia was associated with number of antibiotics administered and prior administration of echinocandin. Mortality of 14 days was 28.3% (15 patients) and was associated with SOFA score upon infection onset and septic shock, while, appropriate empirical antifungal treatment was associated with better survival.

Conclusions

Prophylactic azole administration prevents development of candidaemia, while, echinocandin administration predisposes to non-albicans candidaemia. Empirical administration of an appropriate antifungal agent is associated with better survival.

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Acknowledgements

There was no external financial support received to complete the present study and only institutional funds were used.

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Correspondence to Myrto Christofidou.

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The authors declare that they have no conflict of interest.

Ethical standard

The study was approved by the Hospital Ethics Committee (HEC No: 571).

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Papadimitriou-Olivgeris, M., Spiliopoulou, A., Fligou, F. et al. Risk factors and predictors of mortality of candidaemia among critically ill patients: role of antifungal prophylaxis in its development and in selection of non-albicans species. Infection 45, 651–657 (2017). https://doi.org/10.1007/s15010-017-1050-z

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  • DOI: https://doi.org/10.1007/s15010-017-1050-z

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