Background

Candidemia is a life-threatening fungal infection characterized by the presence of Candida in the blood.

Aims

To describe the clinical–epidemiological features and main risk factors among patients with candidemia admitted to Intensive Care Unit.

Methods

A cross-sectional, retrospective and observational study was performed between January 2015 and July 2016. Laboratory reports and medical records from ICU patients admitted to a public hospital in northeastern Brazil were analyzed.

Results

There were 1573 admissions and 67 of them were positive for candidemia. The majority of patients were male (53.3%) and remained at the hospital for more than seven days (86.6%). Non-C. albicans Candida infections (60%) were predominant. Broad-spectrum antibiotic therapy was prescribed in 98.4% of the cases. The most frequent underlying diseases were sepsis (73.3%), presence of solid tumors (15%), respiratory condition (60%), urinary tract disease (56.6%) and gastrointestinal tract diseases (23.3%). Surgeries were carried out on 43% of the patients, consisting of 23.3% abdominal surgeries, with a mortality rate of 92.8%. Risk factors were venous central access (93.3%), mechanical ventilation (81.6%), nasoenteral tube (83.3%), nasogastric tube (25%), indwelling bladder catheter (88.3%), diabetes mellitus (55%) and tracheostomy (36.6%). Statistical analysis correlated the use of indwelling bladder catheter with a higher mortality rate (r = 0.07412, p = 0.0353).

Conclusions

The current study reveals the high case fatality rates among critically ill patients suffering from candidemia admitted to ICU. Herein, we highlight the importance of identifying non-C. albicans Candida species and reinforce the idea of carrying out epidemiological surveillances and antifungal susceptibility tests.

中文翻译：

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巴西东北部一家公立医院的念珠菌血症：重症患者的流行病学特征和危险因素。

背景

念珠菌血症是威胁生命的真菌感染，其特征是血液中存在念珠菌。

目的

描述重症监护病房的念珠菌血症患者的临床流行病学特征和主要危险因素。

方法

在2015年1月至2016年7月之间进行了横断面，回顾性和观察性研究。分析了巴西东北部公立医院收治的ICU患者的实验室报告和病历。

结果

有1573例入院，其中67例为念珠菌血症阳性。大多数患者为男性（53.3％），并在医院呆了超过7天（86.6％）。非白色念珠菌 念珠菌感染（60％）占主导地位。98.4％的病例开了广谱抗生素治疗。最常见的基础疾病是败血症（73.3％），存在实体瘤（15％），呼吸道疾病（60％），泌尿系统疾病（56.6％）和胃肠道疾病（23.3％）。对43％的患者进行了手术，其中包括23.3％的腹部手术，死亡率为92.8％。危险因素为静脉中心通路（93.3％），机械通气（81.6％），鼻肠管（83.3％），鼻胃管（25％），留置膀胱导管（88.3％），糖尿病（55％）和气管切开术（36.6） ％）。统计分析表明，使用留置膀胱导管与较高的死亡率相关（r  = 0.07412，p  = 0.0353）。

结论

目前的研究表明，重症监护病房的重症患者入院病死率很高。在此，我们着重指出了鉴定非白色念珠菌 念珠菌物种的重要性，并加强了进行流行病学监测和抗真菌药敏试验的想法。