Risk factors for candidaemia in critically ill patients: a prospective surveillance study*

Jordà-Marcos, Ricard; Álvarez-Lerma, Francisco; Jurado, Maite; Palomar, Mercedes; Nolla-Salas, Juan; Leon, M. A. Mendes de; León, Cristóbal

doi:10.1111/j.1439-0507.2007.01366.x

Cited by 83 publications

(79 citation statements)

References 46 publications

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“…2 Candidaemia is frequently a life threatening complication in patients admitted in ICUs. 1 The presence of Candida species in the urine is also common among hospitalized patients. The principal risk factors include antibiotic therapy, urinary catheterization, surgical procedures, female sex and extended hospitalization.…”

Section: Original Articlementioning

confidence: 99%

“…These pathogens are associated with increasing morbidity and mortality. 1,2 Over past two decades, there has been a change in the distribution of Candida spp. causing nosocomial infections and emerging species are C. tropicalis, C. glabrata, C. parapsilosis, C. krusei, and C. lusitaniae.…”

Section: Original Articlementioning

confidence: 99%

“…Extensive and inappropriate use of antimicrobial agents as well as use of immunosuppressant drugs in various diseases has contributed to the increased propensity for opportunistic fungal infections. 1 An important factor for opportunistic fungal infections is hospitalization of patients, especially in an intensive care unit (ICU). The most common fungi involved in invasive disease in humans are opportunistic yeasts like Candida albicans or filamentous fungi like Aspergillus spp.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Original Articlementioning

confidence: 99%

Section: Original Articlementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…Those rules have been applied in various settings and have included assessment at different times postadmission to the ICU and different types of ICU (surgical ICUs only or mixed medical/surgical ICUs-defined as units that house both medical and surgical populations). These differences may explain why predictive models and algorithms have performed poorly outside their derivative populations (17).Since IC is preceded by colonization of mucosal surfaces with the infecting strain (14,(18)(19)(20) and since colonization is an independent risk factor for IC (14,19,21,22), it is logical that it should be incorporated into predictive models (15,16). Using data from mixed medical/surgical ICUs in Australia, we demonstrated that the post hoc addition of colonization parameters to two published clinical risk factor-only predictive models improved their performance characteristics (17).…”

mentioning

confidence: 99%

Candida Colonization as a Risk Marker for Invasive Candidiasis in Mixed Medical-Surgical Intensive Care Units: Development and Evaluation of a Simple, Standard Protocol

et al. 2015

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k Colonization with Candida species is an independent risk factor for invasive candidiasis (IC), but the minimum and most practicable parameters for prediction of IC have not been optimized. We evaluated Candida colonization in a prospective cohort of 6,015 nonneutropenic, critically ill patients. Throat, perineum, and urine were sampled 72 h post-intensive care unit (ICU) admission and twice weekly until discharge or death. Specimens were cultured onto chromogenic agar, and a subset underwent molecular characterization. Sixty-three (86%) patients who developed IC were colonized prior to infection; 61 (97%) tested positive within the first two time points. The median time from colonization to IC was 7 days (range, 0 to 35). Colonization at any site was predictive of IC, with the risk of infection highest for urine colonization (relative risk [RR] ‫؍‬ 2.25) but with the sensitivity highest (98%) for throat and/or perineum colonization. Colonization of >2 sites and heavy colonization of >1 site were significant independent risk factors for IC (RR ‫؍‬ 2.25 and RR ‫؍‬ 3.7, respectively), increasing specificity to 71% to 74% but decreasing sensitivity to 48% to 58%. Molecular testing would have prompted a resistance-driven decision to switch from fluconazole treatment in only 11% of patients infected with C. glabrata, based upon species-level identification alone. Positive predictive values (PPVs) were low (2% to 4%) and negative predictive values (NPVs) high (99% to 100%) regardless of which parameters were applied. In the Australian ICU setting, culture of throat and perineum within the first two time points after ICU admission captures 84% (61/73 patients) of subsequent IC cases. These optimized parameters, in combination with clinical risk factors, should strengthen development of a setting-specific risk-predictive model for IC. Invasive candidiasis (IC), particularly, candidemia, is a significant cause of mortality in critically ill patients, accounting for almost a third of nosocomial infections in intensive care units (ICUs) (1, 2). Early antifungal therapy reduces IC-related mortality and approximately halves the incidence of IC (3-8). Untargeted prophylactic antifungal use, however, is expensive, has the potential to cause adverse drug reactions, and may select for resistant fungal species (9).Clinical risk prediction rules that identify the high-risk patients most likely to benefit from prophylaxis have been developed (10-16), but those studies have used different sets of predictors, including (a) clinical risk factors only and (b) clinical risk factors in combination with colonization indices (CIs). Those rules have been applied in various settings and have included assessment at different times postadmission to the ICU and different types of ICU (surgical ICUs only or mixed medical/surgical ICUs-defined as units that house both medical and surgical populations). These differences may explain why predictive models and algorithms have performed poorly outside their derivative populations (17).Since IC is pr...

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“…C andida albicans is a commensal yeast fungus that colonizes the oropharynx, intestine, and vagina in healthy individuals (1,2). In HIV-infected individuals and other immunocompromised hosts, C. albicans can be a major pathogen, causing oropharyngeal, esophageal, or vulvovaginal candidiasis (3), and it is the fourth most common cause of nosocomial bloodstream infections in the United States with a 38% mortality rate (4). Identification of the mechanisms by which the immune system protects against C. albicans infection is critical for the development of treatments and vaccines against this pathogen.…”

mentioning

confidence: 99%

Candida albicansStimulates IL-23 Release by Human Dendritic Cells and Downstream IL-17 Secretion by Vδ1 T Cells

Maher

Dunne

Comerford

et al. 2015

The Journal of Immunology

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γδ T cells expressing the Vδ1 TCR are expanded in patients with HIV infection. We show in this article that circulating Vδ1 T cell numbers are particularly high in patients with HIV and candidiasis, and that these cells expand and produce IL-17 in response to Candida albicans in vitro. Although C. albicans could directly stimulate IL-17 production by a subset of Vδ1 T cells, fungus-treated dendritic cells (DCs) were required to expand C. albicans–responsive Vδ1 T cells to generate sufficient numbers of cells to release IL-17 at levels detectable by ELISA. C. albicans induced the release of IL-1β, IL-6, and IL-23 by DCs, but addition of these cytokines or supernatants of C. albicans–treated DCs to Vδ1 T cells was not sufficient to induce proliferation. We found that direct contact with DCs was required for Vδ1 T cell proliferation, whereas IL-23R–blocking studies showed that IL-23 was required for optimal C. albicans–induced IL-17 production. Because IL-17 affords protection against both HIV and C. albicans, and because Vδ1 T cells are not depleted by HIV, these cells are likely to be an important source of IL-17 in HIV-infected patients with candidiasis, in whom CD4+ Th17 responses are impaired. These data show that C. albicans stimulates proliferation and IL-17 production by Vδ1 T cells by a mechanism that involves IL-23 release by DCs.

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Risk factors for candidaemia in critically ill patients: a prospective surveillance study*

Cited by 83 publications

References 46 publications

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

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

Candida Colonization as a Risk Marker for Invasive Candidiasis in Mixed Medical-Surgical Intensive Care Units: Development and Evaluation of a Simple, Standard Protocol

Candida albicansStimulates IL-23 Release by Human Dendritic Cells and Downstream IL-17 Secretion by Vδ1 T Cells

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