Epidemiological features of Candida infections detected in intensive care units and risk factors affecting mortality

Abstract

The aim of this study was to describe the epidemiological features of nosocomial Candida infections in intensive care units and to detect the risk factors which increase the mortality rate. A total of 940 patients hospitalized in ICUs of Gulhane Military Medical Academy Hayclarpasa Training Hospital, Istanbul, between January 01 and December 31, 2006 were prospectively enrolled into this study. Candida spp. were isolated from various clinical specimens (blood, urine, respiratory tract, wound) in 48 patients. Of these patients, 50% were male and 50% were female, and the mean age was 63.66 +/- 22.72 (age range: 8-92) years. The mean duration of hospital stay was 36.25 +/- 44.51 (min: 1, max: 90) days. Thirty five Candida infection attacks were observed in 29 of 48 patients. C. albicans was isolated in 18 infections and non-albicans Candida spp. in 17 infections. Nosocomial infection rate due to Candida spp. was 3.22 per 1000 patient-days. The most common Candida infections were bloodstream (42.9%) and urinary tract infections (37.1%). At the time of diagnosis, 89.6% of patients were being hospitalized for more than ten days and 69% of the patients were using three or more wide spectrum antibiotics. Diabetes mellitus and cardiovascular diseases were the most frequently detected co-morbid diseases. The overall mortality rate was 55.2%. Predictors of adverse outcome were diabetes mellitus (p = 0.016), need for mechanical ventilation (p = 0.010) and infection with non-olbicans Candida spp. (p = 0.002). In conclusion, Candida infections in the intensive care patients are associated with high mortality. Mortality due to Candida infections could be reduced by defining the risk factors and starting preemptive antifungal treatment to patients who are under risk.