Candida spp. colonization significance in critically ill medical patients: a prospective study

Charles, Pierre‐Emmanuel; Dalle, Frédéric; Aube, Hervé; Doise, Jean Marc; Quenot, Jean‐Pierre; Aho, Ludwig Serge; Chavanet, P.; Blettery, B

doi:10.1007/s00134-005-2571-y

Cited by 155 publications

(121 citation statements)

References 31 publications

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“…(such as indwelling catheters, renal failure, total parenteral nutrition, etc.) are difficult to modify 5,[30][31][32][33][34] especially among NTES patients that require urgent interventions. Surprisingly, even patients colonized with Candida had prolonged ICU stays and higher total hospital costs.…”

Section: Discussionmentioning

confidence: 99%

Candidainfection and colonization among non-trauma emergency surgery patients

Kourkoumpetis

Manolakaki²,

Velmahos³

et al. 2010

Virulence

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IntroductionCandida is a fungus, which accounts for nearly 96% of all opportunistic mycoses and is the fourth most common bloodstream pathogen in North American and seventh in European hospitals. 1,2 Among critically ill patients, candidiasis is associated with overall severity of illness, increased rate of invasive interventions, use of broadspectrum antibiotics and parenteral nutrition, which are all unavoidable among critically ill patients.3-5 Candidiasis prolongs both intensive care unit (ICU) and hospital stays and candidemia can increase hospital cost by $40,000 per survivor.6,7 Nonetheless, in a nationwide study the crude mortality of candidemia in the ICU was 47%. Even though candidiasis has been well studied in other critically ill patient groups such as trauma patients as well as in certain high-risk groups, such as patients with neutropenia, bone marrow transplant recipients or HIV-infected individuals, literature examining specific risk factors for candidiasis among non-trauma emergency surgery patients is lacking. This patient Background: candida is a significant pathogen among critically ill patients. however, candidiasis among non-trauma emergency surgery (NTeS) patients has not been previously investigated. herein we describe the incidence of both colonization and infection from candida and risk factors for invasive disease in this population. Results: Of all 289 eligible patients, 63 (21.7%) fulfilled the criteria for candida infection and 110 (38%) were included in the candida colonization group. Interestingly, from the 63 patients with invasive candidiasis, 25 (39.7%) were infected by a non-albicans species. Upon multivariate analyses, ventilator-associated pneumonia (Vap) (Odds Ratio [OR]: 2.34; 95%, confidence Interval [cI]: 1,213-4,533, p = 0.0112), bacteremia (OR: 4,778; 95% cI: 1,519-15,029, p = 0.0075) and surgical complications (OR: 3.903; 95% cI: 1,335-11,412, p = 0.0129) were independent risk factors for the development of candida infection. candida infection and colonization were both found to correlate with approximately $40,000-100,000 mean additional costs). Interestingly, candidemia was associated with 63% all-cause mortality. For all other forms of candidiasis, mortality was not significantly different among groups. Methods: For this retrospective single center study we included all NTeS patients with IcU stay ≥4 days from May 1 st , 2002 to april 30 th , 2007. patients were divided into 3 non-overlapping groups: (1) patients with candida-infection, (2) patients with candida colonization and (3) patients with negative candida cultures. Groups were compared by univariate and multivariate analyses to identify significant risk factors for invasive candidiasis. Conclusion: We found that candida infection is alarmingly high among NTeS patients with prolonged intensive care unit (IcU) stay. Surgical complications and bacterial infections (Vap and bacteraemia) were significantly correlated with the development of candidiasis. candidiasis reached a rate of 21.7/100 discharges, which is...

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Section: Discussionmentioning

confidence: 99%

Candidainfection and colonization among non-trauma emergency surgery patients

Kourkoumpetis

Manolakaki²,

Velmahos³

et al. 2010

Virulence

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“…The reason for ICU admission was medical in 18.8 % of patients, surgical in 76.1 %, and trauma in 5.1 %. The median (IQR) length of ICU and hospital stay was 15 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) and 38 (24-57) days, respectively, which were significantly higher in patients with IC compared to the other two groups. ICU and hospital crude mortality rates were 26.7 and 32.4 %, respectively.…”

Section: Study Population and Salient Findingsmentioning

confidence: 95%

“…was simultaneously isolated from various noncontiguous sites, even if two different Candida spp. were isolated [14,15].…”

Section: Definitionsmentioning

confidence: 99%

Value of β-d-glucan and Candida albicans germ tube antibody for discriminating between Candida colonization and invasive candidiasis in patients with severe abdominal conditions

et al. 2012

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“…3 Moreover, multiple site colonization with Candida species is also being commonly recognized as a major risk factor for invasive fungal infections in critically ill patients. 4 There is paucity of data from India on fungal infections in the critical care setting with variable results. [5][6][7][8][9][10][11] These studies are mainly from Delhi and there have been sporadic reports fro m Ko lkat a, Pune, Chandigarh and Dehradun.…”

Section: Original Articlementioning

confidence: 99%

Epidemiology of fungal infections in critical care setting of a tertiary care teaching hospital in North India: a prospective surveillance study

Singh¹,

Kashyap²,

Ahluwalia³

et al. 2014

JCSR

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Background: During recent years, fungal infections have risen exponentially and are a cause of significant morbidity and mortality in hospitalized patients, especially in the critical care setting. There is paucity of data from India on fungal pathogens. Methods:We prospectively studied patients admitted to medical and surgical critical care section of a tertiary care institute in northern India. The clinical samples of patients were processed in Department of Microbiology for isolation and identification of fungi by using standard protocols over a period of one year. The patients were categorized into fungal infection and colonization groups. The demographic data and risk factors for fungal infection and colonization were evaluated.Results: Ninety one (82.7%) of the 110 patients enrolled in the study, had fungal infection, whereas 19 (17.3%) had fungal colonization. Candida were isolated from 85/91 (93.4%) and 19/19 (100%) patients with fungal infection and colonization respectively. There was predominance of non-albicans Candida spp both in fungal infection 61/85 (71.7%) patients as well as fungal colonization group 16/19 (84.2% ). In non-albicans Candida spp., Candida tropicalis was the most common isolate observed in both fungal infection (85.3%) and fungal colonization (63.1%) groups. Overall, in patients with fungal infection, candiduria was detected in 68/91 (74.7%) whereas candidaemia was observed in 19/ 91 (20.8%) patients. The risk factors for fungal infections included urinary catheterization (85.7%), central line insertion (81.3%), mechanical ventilation (52.7%), use of corticosteroids (23.1%), total parentral nutrition (6.6%) and peritoneal dialysis (3.3%). Conclusions:The emergence of non-albicans Candida similar to the trends in the western countries should be a cause of concern in our country. Proper surveillance of fungal pathogens is important to improve quality of care in critical care setting and measures should be focussed to control these infections, especially in patients with these risk factors.

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Candida spp. colonization significance in critically ill medical patients: a prospective study

Cited by 155 publications

References 31 publications

Candidainfection and colonization among non-trauma emergency surgery patients

Candidainfection and colonization among non-trauma emergency surgery patients

Value of β-d-glucan and Candida albicans germ tube antibody for discriminating between Candida colonization and invasive candidiasis in patients with severe abdominal conditions

Epidemiology of fungal infections in critical care setting of a tertiary care teaching hospital in North India: a prospective surveillance study

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