Background

Crit Care

Critical Care

1364-85351466-609X

BioMed Central

3333286

cc1166

10.1186/cc1166

Meeting Abstract

Risk factors for Candida colonization/infection in non-neutropenic medical critically ill patients

Nolla

1León

2Jordá

3León

4Pontes

5Casado

1Hospital del Mar, Barcelona, Spain2Hospital University de Valme, Seville, Spain3Hospital de Son Dureta, Palma de Mallorca, Spain4Hospital General de Catalunya, Barcelona, Spain5Gilead Farmaceútica, SA, Madrid, Spain

2001

232001

5Suppl 1

21st International Symposium on Intensive Care and Emergency Medicine

P099P0991512001

20-23 March 2001

21st International Symposium on Intensive Care and Emergency Medicine

Brussels, Belgium

Background

To evaluate the risk factors of Candida colonization/infection in the non-neutropenic medical critically ill patients (pts) who were admitted to ICUs.

Methods

Prospective observational multicenter study from May 1998–January 1999 in pts staying ≥ 7 days in 73 Spanish intensive care units (ICU). Surveillance cultures were performed weekly from: tracheal aspirates, urine, and gut (oropharynx ± gastric aspirates). The pts were catalogued in two groups: colonized (appearance or persistence of Candida in surveillance cultures) and invasive candidiasis (IC) (defined as any one or more of the conditions following: candidemia, endophtalmitis, other infections: peritonitis, organ biopsy). Multisite colonization (MC) was defined as ≥ 2 sites positive from surveillance cultures, and persistent MC as positive cultures in ≥ 1 week. The pts were clasified in two groups, medical, and surgical-traumatic. Demographic variables, APACHE II, comorbidity, associated risk factors and outcome were analized and compared between the two groups.

Results

We analyzed 1765 consecutive pts: 961 were considered colonized or infected by Candida species: 468 were medical, 309 surgical and 184 traumatic pts. In the medical group 438 were colonized (persistent MC, 78 pts; non-persistent MC, 183 pts; and in a single site, 202 pts, and 30 (6.4%) were in IC group. C. albicans was the most prevalent (82.4%). Univariate analysis identified factors to be associated with Candida colonization/infection in the medical pts: age, APACHE II, diabetes, COPD, hematologic malignancies, renal insufficiency, immunosupression, steroid therapy time, and mortality rate (intra-ICU and hospital). By stepwise logistic regression, hematologic malignancies (OR 6.0 [95% CI, 1.1-31.4]), diabetes (OR 2.4 [95% CI, 1.4-4.2]), and enteral nutrition (OR 2.2 [95% CI, 1.4-3.6]), proved to predict the development of Candida presence in medical pts independently.

Conclusions

Hematologic malignancies, diabetes and enteral nutrition are independently significant risk factors for Candida colonization/infection in medical critically ill patients.