TY - JOUR
T1 - Factors associated with candidemia caused by non-albicans Candida species versus Candida albicans in the intensive care unit
AU - Chow, Jennifer K.
AU - Golan, Yoav
AU - Ruthazer, Robin
AU - Karchmer, Adolf W.
AU - Carmeli, Yehuda
AU - Lichtenberg, Deborah
AU - Chawla, Varun
AU - Young, Janet
AU - Hadley, Susan
N1 - Funding Information:
Potential conflicts of interest. Y.G. has received research funding from Pfizer and Merck and has been a member of the speaker’s bureau for Schering-Plough. A.W.K. has received research funding from and has served as a consultant and advisory board member for Pfizer. D.L. is currently employed by Bard Medical Division. S.H. has received research funding from Pfizer; has served as a consultant to Astellas, Domantis, Pfizer, and Schering-Plough; and has been on the speaker’s bureau for Astellas, Enzon, Merck, Pfizer, and Schering-Plough. Y.C. has received grants, honoraria, travel support, and consulting fees from Basilea Pharmaceutica, Bioline Therapeutics, Cempra Pharmaceuticals, Johnson and Johnson, Merck, Neo-pharm, Pfizer, Wyeth, and XTL. All other authors: no conflicts.
PY - 2008/4/15
Y1 - 2008/4/15
N2 - Background. Candida albicans has been the most common cause of fungal bloodstream infections (BSIs) in intensive care units (ICUs); however, infections due to non-albicans Candida species have been increasing in prevalence. We examined factors associated with BSIs due to non-albicans Candida species, compared with C. albicans BSIs, in an ICU patient population. Methods. For our case-comparator study, we identified consecutive adult ICU patients with BSIs due to nonalbicans Candida species or C. albicans at 2 tertiary care hospitals during the period 1995-2005. Data collected included demographic characteristics, comorbidities, exposure to antibiotics and antifungals, and ICU-related factors, such as total parenteral nutrition, blood product transfusions, invasive procedures, central venous catheter use, hemodialysis, and mechanical ventilation. We built a multivariable logistic regression model that identified variables that differentiate BSIs due to non-albicans Candida species from BSIs due to C. albicans. Results. There were 67 patients with BSIs due to non-albicans Candida species and 79 patients with C. albicans BSIs. Variables were adjusted for time at risk. In multivariable models, factors associated with an increased risk of BSIs due to non-albicans Candida species, compared with C. albicans BSIs, included fluconazole exposure (odds ratio, 11.6; 95% confidence interval, 2.28-58.8), central venous catheter exposure (odds ratio, 1.95; 95% confidence interval, 1.10-3.47), and mean number of antibiotics per day (odds ratio, 2.31; 95% confidence interval, 0.71-7.54). Total parenteral nutrition exposure was associated with a decreased risk (odds ratio, 0.16; 95% confidence interval, 0.05-0.47) of BSIs due to non-albicans Candida species, compared with C. albicans BSIs. Duration of stay in the ICU was not significantly different between the 2 groups. Specific antibiotics, such as vancomycin and piperacillin-tazobactam, were not independently associated with BSI due to non-albicans Candida species. Conclusions. Receipt of fluconazole and central venous catheter exposure were associated with an increased risk of BSI due to non-albicans Candida species, and total parenteral nutrition was associated with a decreased risk of BSI due to non-albicans Candida species, compared with BSI due to C. albicans. Patients without characteristics of infection due to non-albicans Candida species might benefit from empirical antifungal therapy with fluconazole.
AB - Background. Candida albicans has been the most common cause of fungal bloodstream infections (BSIs) in intensive care units (ICUs); however, infections due to non-albicans Candida species have been increasing in prevalence. We examined factors associated with BSIs due to non-albicans Candida species, compared with C. albicans BSIs, in an ICU patient population. Methods. For our case-comparator study, we identified consecutive adult ICU patients with BSIs due to nonalbicans Candida species or C. albicans at 2 tertiary care hospitals during the period 1995-2005. Data collected included demographic characteristics, comorbidities, exposure to antibiotics and antifungals, and ICU-related factors, such as total parenteral nutrition, blood product transfusions, invasive procedures, central venous catheter use, hemodialysis, and mechanical ventilation. We built a multivariable logistic regression model that identified variables that differentiate BSIs due to non-albicans Candida species from BSIs due to C. albicans. Results. There were 67 patients with BSIs due to non-albicans Candida species and 79 patients with C. albicans BSIs. Variables were adjusted for time at risk. In multivariable models, factors associated with an increased risk of BSIs due to non-albicans Candida species, compared with C. albicans BSIs, included fluconazole exposure (odds ratio, 11.6; 95% confidence interval, 2.28-58.8), central venous catheter exposure (odds ratio, 1.95; 95% confidence interval, 1.10-3.47), and mean number of antibiotics per day (odds ratio, 2.31; 95% confidence interval, 0.71-7.54). Total parenteral nutrition exposure was associated with a decreased risk (odds ratio, 0.16; 95% confidence interval, 0.05-0.47) of BSIs due to non-albicans Candida species, compared with C. albicans BSIs. Duration of stay in the ICU was not significantly different between the 2 groups. Specific antibiotics, such as vancomycin and piperacillin-tazobactam, were not independently associated with BSI due to non-albicans Candida species. Conclusions. Receipt of fluconazole and central venous catheter exposure were associated with an increased risk of BSI due to non-albicans Candida species, and total parenteral nutrition was associated with a decreased risk of BSI due to non-albicans Candida species, compared with BSI due to C. albicans. Patients without characteristics of infection due to non-albicans Candida species might benefit from empirical antifungal therapy with fluconazole.
UR - http://www.scopus.com/inward/record.url?scp=42549152508&partnerID=8YFLogxK
U2 - 10.1086/529435
DO - 10.1086/529435
M3 - Article
C2 - 18444857
AN - SCOPUS:42549152508
SN - 1058-4838
VL - 46
SP - 1206
EP - 1213
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 8
ER -