Dr Lo Yick Cheung, Eugene, ICU of Rutonjee Hospital, Hong Kong
Background:
Candida albicans has been the most common cause of fungal bloodstream infections in critically ill patients. However, infections due to non-albicans Candida species have been increasing recently. Candida species produce a wide spectrum of diseases, ranging from superificial mucocutaneous disease to invasive illnesses, such as hepatosplenic candidiasis, Candida peritonitis, and systemic candidasis. The management of serious and life-threatening invasive candidiasis remains challenging in view of delays in diagnosis and lack of reliable diagnostic methods that allow detection of both fungaemia and tissue invasion by Candida species.
Candida albicans has been the most common cause of fungal bloodstream infections in critically ill patients. However, infections due to non-albicans Candida species have been increasing recently. Candida species produce a wide spectrum of diseases, ranging from superificial mucocutaneous disease to invasive illnesses, such as hepatosplenic candidiasis, Candida peritonitis, and systemic candidasis. The management of serious and life-threatening invasive candidiasis remains challenging in view of delays in diagnosis and lack of reliable diagnostic methods that allow detection of both fungaemia and tissue invasion by Candida species.
Objective:
To determine the clinical features, risk factor and outcome of critically ill patient with non-albicans candidaemia.
To determine the clinical features, risk factor and outcome of critically ill patient with non-albicans candidaemia.
Design:
Retrospective, observational study
Setting:
The study was conducted in 3 Intensive Care Units (ICU) in Hong Kong (Queen Mary Hospital, QMH; Pamela Youde Eastern Hospital, PYNEH and Ruttonjee Hospital, RH)
Patients:
All patients with intensive care unit acquired candidema or with candidemia that need ICU care was included. Study period from 1st Jan 2007 to 31st Dec 2011.
Methods:
Data collected included demographic characteristics, comorbidities, exposures to antibiotics and antifungals, and ICU – related factors, such as total parental nutrition, blood product transfusions, invasive procedures, central venous catheter use, haemodialysis, and mechanical ventilation.
Results: Total 111 patients with Candidaemiawere identified during the 5 years of study period (Point prevalence, 6.7 per 1000 ICU admissions). Among the 111 patients with episodes of candidaemia, 45 had albicans candidaemia and 66 had non-albicans candidaemia. Candida non-albicans was the predominant species. The distribution of Candida non-albicans species was candida glabrata 23/111 (20.7%), Candida tropicalis 23/111 (20.7%), Candida parapsilosis 16/111 (14.4%), Candida Krusei 3/111 (2.7%), Candida Guilliermondii 1/111 (0.9%). The speciality of patient, recent history of organ transplant, and pre-existing neutropenia were independently associated with candidaemia due to Candida non-albicans species (odd ratio [OR]: 3.317 95% confidence interval [CI]:0.213-1.058;OR: 2.254, 95% CI 0.02 – 1.679; and OR .073 95% CI: 0.041-0.954 respectively). But the association did not reach statistical significance. Patient’s age, APACHE II score, history of diabetes mellitus, patients suffered from active malignancy, central venous catheter placement, mechanical ventilation use and recent abdominal surgery were associated with mortality in univariable analysis. Multivariable logistic regression analysis revealed that only patients with mechanical ventilation and APACHE II score on admission were independently associated with death. (OR: 3.425, 95% CI 0.075 – 1.077; OR:2.869, 95% CI 0.987 – 1.201). But no statistical significance noted. Among the studied critically ill patients with candidaemia, mortality was comparable between those with Candida albicans species and Candida non-albicans blood-stream infection. (32/45 [71.1%] vs 46/66 [69.7%], p=0.479).
Conclusion:
In this study data revealed an overall increase in prevalence of Candidaemia. Non-albicans candidaemia were becoming more predominates. The epidemiology of Candidaemia in Hong Kong seems to be differ from other countries in Asia-Pacific, North America and Europe.
In this study data revealed an overall increase in prevalence of Candidaemia. Non-albicans candidaemia were becoming more predominates. The epidemiology of Candidaemia in Hong Kong seems to be differ from other countries in Asia-Pacific, North America and Europe.