Predisposing factors for candidemia in patients with major burns

Fochtmann, Alexandra; Forstner, Christina; Hagmann, Michael; Keck, Maike; Muschitz, Gabriela; Presterl, Elisabeth; Ihra, Gerald; Rath, Thomas

doi:10.1016/j.burns.2014.07.004

Cited by 21 publications

(26 citation statements)

References 35 publications

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“…Univariate analysis showed that prior antibiotic therapy, skin allograft or artificial dermis use, parenteral nutrition, abdominal surgery, diabetes mellitus, burn size, RRT and Pseudomonas aeruginosa colonisation were associated with candidemia. These results are in accordance with the major risk factors described in the literature and are consistent with the pathophysiology of candidemia in burns patients . Indeed, fungal infections with Candida spp.…”

Section: Discussionsupporting

confidence: 92%

“…Likewise, Cochran et al reported a candidemia incidence of 3.5% in the same population . 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 …”

Section: Discussionsupporting

confidence: 87%

“…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 …”

Section: Discussionmentioning

confidence: 57%

“…Candidemia occurs in 2%‐11% of patients with extensive burns and is reported to have a high attributable mortality that can reach 41% . Only a few studies have investigated risk factors of candidemia in severely burned patients . The identification of specific risk factors for candidemia (high colonisation index, broad‐spectrum antibiotics, parenteral nutrition) is crucial and could help not only in identifying high‐risk burns patients more likely to benefit from empiric antifungal treatment strategies, but also controlling potentially modifiable risk factors to improve outcome.…”

Section: Introductionmentioning

confidence: 99%

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

Dudoignon

Alanio

Anstey

et al. 2018

Mycoses

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Summary Background Patients with extensive burns are at risk of developing candidemia. Objectives To identify potentially modifiable risk factors and outcomes of candidemia in critically ill burns patients. Patients and Methods Retrospective matched cohort study including adult burns patients. Patients who developed candidemia were matched with burns patients with Candida spp colonisation and sepsis or septic shock without candidemia in a ratio of 1:3 (same severity scores and colonisation index). Univariate and multiple regression analyses were performed. Results Of 130 severely burned patients with Candida spp colonisation and at least one episode of sepsis or septic shock, 14 were diagnosed with candidemia. In the candidemia group, patients had a median (IQR) total burns surface area (TBSA) of 57 (38‐68)%, SAPSII of 43 (36‐58) and ABSI of 11 (8‐13). Multiple regression analysis showed that only duration of prior antibiotic therapy was independently associated with candidemia. ICU mortality was higher in the candidemia group (71% vs 35% [P = 0.02]). The log‐rank test for 28‐day mortality comparing patients with candidemia treated with an empirical strategy vs a curative strategy did not reach significance (P = 0.056). Conclusions Burns patients having received recent antibiotherapy have a higher risk of candidemia. Antifungal strategies did not influence outcome in this series.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

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

Dudoignon

Alanio

Anstey

et al. 2018

Mycoses

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“…Early surgery with resection of burnt tissue and extensive debridement of necrotic parts followed by skin grafts or substitutes enormously reduce the mortality rates associated with severe burns. However, advances in the care of burn patients with the growing use of broad‐spectrum antibiotics, immunosuppressant agents, prosthetic devices and total parenteral nutrition have been associated with an increase in the incidence of opportunistic life‐threatening infections, such as invasive fungal infections …”

Section: Introductionmentioning

confidence: 99%

Candidemia in major burns patients

Escrig

Salavert

Vivo

et al. 2016

Mycoses

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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.

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The Changing Epidemiology of Invasive Fungal Infections

Enoch

Yang

Aliyu

et al. 2016

Methods in Molecular Biology

315

208

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Invasive fungal infections (IFI) are an emerging problem worldwide with invasive candidiasis and candidemia responsible for the majority of cases. This is predominantly driven by the widespread adoption of aggressive immunosuppressive therapy among certain patient populations (e.g., chemotherapy, transplants) and the increasing use of invasive devices such as central venous catheters (CVCs). The use of new immune modifying drugs has also opened up an entirely new spectrum of patients at risk of IFIs. While the epidemiology of candida infections has changed in the last decade, with a gradual shift from C. albicans to non-albicans candida (NAC) strains which may be less susceptible to azoles, these changes vary between hospitals and regions depending on the type of population risk factors and antifungal use. In certain parts of the world, the incidence of IFI is strongly linked to the prevalence of other disease conditions and the ecological niche for the organism; for instance cryptococcal and pneumocystis infections are particularly common in areas with a high prevalence of HIV disease. Poorly controlled diabetes is a major risk factor for invasive mould infections. Environmental factors and trauma also play a unique role in the epidemiology of mould infections, with well-described hospital outbreaks linked to the use of contaminated instruments and devices. Blastomycosis is associated with occupational exposure (e.g., forest rangers) and recreational activities (e.g., camping and fishing).The true burden of IFI is probably an underestimate because of the absence of reliable diagnostics and lack of universal application. For example, the sensitivity of most blood culture systems for detecting candida is typically 50 %. The advent of new technology including molecular techniques such as 18S ribosomal RNA PCR and genome sequencing is leading to an improved understanding of the epidemiology of the less common mould and dimorphic fungal infections. Molecular techniques are also providing a platform for improved diagnosis and management of IFI.Many factors affect mortality in IFI, not least the underlying medical condition, choice of therapy, and the ability to achieve early source control. For instance, mortality due to pneumocystis pneumonia in HIV-seronegative individuals is now higher than in seropositive patients. Of significant concern is the progressive increase in resistance to azoles and echinocandins among candida isolates, which appears to worsen the already significant mortality associated with invasive candidiasis. Mortality with mould infections approaches 50 % in most studies and varies depending on the site, underlying disease and the use of antifungal agents such as echinocandins and voriconazole. Nevertheless, mortality for most IFIs has generally fallen with advances in medical technology, improved care of CVCs, improved diagnostics, and more effective preemptive therapy and prophylaxis.

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Predisposing factors for candidemia in patients with major burns

Cited by 21 publications

References 35 publications

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

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

Candidemia in major burns patients

The Changing Epidemiology of Invasive Fungal Infections

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