Candidemia in major burns patients

Abstract

Major burn patients have characteristics that make them especially susceptible to candidemia, but few studies focused on this have been published. The objectives were to evaluate the epidemiological, microbiological and clinical aspects of candidemia in major burn patients, determining factors associated with a poorer prognosis and mortality. We conducted a retrospective observational study of candidemia between 1996 and 2012 in major burn patients admitted to the La Fe University Hospital, Valencia, Spain. The study included 36 episodes of candidemia in the same number of patients, 55.6% men, mean age 37.33 years and low associated comorbidity. The incidence of candidemia varied between 0.26 and 6.09 episodes/1000 days stay in the different years studied. Candida albicans was the most common species (61.1%) followed by Candida parapsilosis (27.8%). Candidemia by C. krusei, C. glabrata or C. tropicalis were all identified after 2004. Central vascular catheter (CVC) was established as a potential source of candidemia in 36.1%, followed by skin and soft tissues of thermal injury (22.2%) and urinary tract (8.3%). Fluconazole was used in 19 patients (52.7%) and its in vitro resistance rate was 13.9%. The overall mortality was 47.2%, and mortality related to candidemia was 30.6%. Factors associated with increased mortality were those related to severe infection and shock. CVC was the most usual focus of candidemia. Fluconazole was the most common antifungal drug administered. The management of candidemia in major burn patients is still a challenge.

Outcome and potentially modifiable risk factors for candidemia in critically ill burns patients: A matched cohort study

“…One study, however, reported a higher incidence of candidemia (11%) . With regard to the duration from ICU admission to candidemia, our findings are very close to those of Fochtmann et al (17 (9‐35) days and 16 (range 6‐89) days from admission respectively) whereas other studies reported longer median intervals of between 25 and 41 days …”

“…In our study, the most commonly isolated species in blood cultures was Candida glabrata , whereas Candida albicans and Candida parapsilosis were the most common isolates from all colonisation sites. Our results reconfirm the previously reported shift in predominance from C. albicans to non‐albicans species, notably C. glabrata over the last decade or so in ICUs …”

“…The likely origin of candidemia in our patients was exclusively burn wounds. This is in contrast to a study by Renau Escrig et al that reported that central vascular catheters were the principal source of candidemia (36.1%) followed by burn wounds (22.2%) . However, that study was limited by the absence of clear triggers mandating the collection of cultures, since in more than 30% of cases the origin of candidemia could not be established.…”

Invasive Candidiasis in Hospitalized Patients with Major Burns

“…According to recent reports, the incidence of IC has been increasing [15], but the rate has varied between different studies. In the study by Escrig et al [14], the incidence of IC was between 0 and 46.3 per 1000 admissions. Zhou et al re-ported an IC rate ranging from 6.06% to 17.54% in a single intensive care unit for burns [16].…”

“…Indwelling medical devices, such as endotracheal tubes, mechanical devices, central venous catheters, urinary catheters, and possibly parenteral nutrition, are necessary for life support in patients with major burns, but they may be sources of IC. Antibiotics are usually prescribed for prolonged prophylaxis or treatment against bacteria and represent another risk factor for IC as an opportunistic infection [14].…”