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Risk factors for candidemia: a prospective matched case-control study

Julien Poissy, Lauro Damonti, Anne Bignon, Nina Khanna, Matthias Von Kietzell, Katia Boggian, Dionysios Neofytos, Fanny Vuotto, Valérie Coiteux, Florent Artru, Stephan Zimmerli, Jean-Luc Pagani, Thierry Calandra, Boualem Sendid, Daniel Poulain, Christian Van Delden, Frédéric Lamoth, Oscar Marchetti, Pierre-Yves Bochud, FUNGINOS & Allfun French Study Groups

abstract

BACKGROUND
Candidemia is an opportunistic infection associated with high morbidity and mortality in patients hospitalized both inside and outside intensive care units (ICUs). Identification of patients at risk is crucial to ensure prompt antifungal therapy. We sought to assess risk factors for candidemia and death, both outside and inside ICUs.

METHODS
This prospective multicenter matched case-control study involved six teaching hospitals in Switzerland and France. Cases were defined by positive blood cultures for Candida sp. Controls were matched to cases using the following criteria: age, hospitalization ward, hospitalization duration, and, when applicable, type of surgery. One to three controls were enrolled by case. Risk factors were analyzed by univariate and multivariate conditional regression models, as a basis for a new scoring system to predict candidemia.

RESULTS
One hundred ninety-two candidemic patients and 411 matched controls were included. Forty-four percent of included patients were hospitalized in ICUs, and 56% were hospitalized outside ICUs. Independent risk factors for candidemia in the ICU population included total parenteral nutrition, acute kidney injury, heart disease, prior septic shock, and exposure to aminoglycoside antibiotics. Independent risk factors for candidemia in the non-ICU population included central venous catheter, total parenteral nutrition, and exposure to glycopeptides and nitroimidazoles. The accuracy of the scores based on these risk factors is better in the ICU than in the non-ICU population. Independent risk factors for death in candidemic patients included septic shock, acute kidney injury, and the number of antibiotics to which patients were exposed before candidemia.

DISCUSSION
While this study shows a role for known and novel risk factors for candidemia, it specifically highlights important differences in their distribution according to the hospital setting (ICU versus non-ICU).

CONCLUSION
This study provides novel risk scores for candidemia accounting for the hospital setting and recent progress in patients' management strategies and fungal epidemiology.
   
citation Poissy J, Damonti L, Bignon A, Khanna N, Von Kietzell M, Boggian K, Neofytos D, Vuotto F, Coiteux V, Artru F, Zimmerli S, Pagani J L, Calandra T, Sendid B, Poulain D, Van Delden C, Lamoth F, Marchetti O, Bochud P Y, FUNGINOS , Allfun French Study Groups . Risk factors for candidemia: a prospective matched case-control study. Crit Care 2020; 24:109.
   
type journal paper/review (English)
date of publishing 18-03-2020
journal title Crit Care (24/1)
ISSN electronic 1466-609X
pages 109
PubMed 32188500
DOI 10.1186/s13054-020-2766-1