Background Candidemia is an opportunistic infection associated with high morbidity and mortality in patients hospitalized both inside and outside intensive care units (ICUs). Identification of patients at risk is crucial to ensure prompt antifungal therapy. We sought to assess risk factors for candidemia and death, both outside and inside ICUs. Methods This prospective multicenter matched case-control study involved six teaching hospitals in Switzerland and France. Cases were defined by positive blood cultures for Candida sp. Controls were matched to cases using the following criteria: age, hospitalization ward, hospitalization duration, and, when applicable, type of surgery. One to three controls were enrolled by case. Risk factors were analyzed by univariate and multivariate conditional regression models, as a basis for a new scoring system to predict candidemia. Results One hundred ninety-two candidemic patients and 411 matched controls were included. Forty-four percent of included patients were hospitalized in ICUs, and 56% were hospitalized outside ICUs. Independent risk factors for candidemia in the ICU population included total parenteral nutrition, acute kidney injury, heart disease, prior septic shock, and exposure to aminoglycoside antibiotics. Independent risk factors for candidemia in the non-ICU population included central venous catheter, total parenteral nutrition, and exposure to glycopeptides and nitroimidazoles. The accuracy of the scores based on these risk factors is better in the ICU than in the non-ICU population. Independent risk factors for death in candidemic patients included septic shock, acute kidney injury, and the number of antibiotics to which patients were exposed before candidemia. Discussion While this study shows a role for known and novel risk factors for candidemia, it specifically highlights important differences in their distribution according to the hospital setting (ICU versus non-ICU). Conclusion This study provides novel risk scores for candidemia accounting for the hospital setting and recent progress in patients’ management strategies and fungal epidemiology.

中文翻译：

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念珠菌血症的危险因素：一项前瞻性匹配病例对照研究

背景念珠菌血症是一种机会性感染，与重症监护病房 (ICU) 内外住院患者的高发病率和死亡率相关。识别有风险的患者对于确保及时进行抗真菌治疗至关重要。我们试图评估 ICU 内外念珠菌血症和死亡的危险因素。方法 这项前瞻性多中心匹配病例对照研究涉及瑞士和法国的六家教学医院。病例定义为念珠菌属的阳性血培养。使用以下标准将对照与病例相匹配：年龄、住院病房、住院时间以及适用的手术类型。一到三个对照按病例登记。通过单变量和多变量条件回归模型分析风险因素，作为预测念珠菌血症的新评分系统的基础。结果共纳入192例念珠菌病患者和411例匹配对照。44% 的纳入患者在 ICU 住院，56% 在 ICU 外住院。ICU 人群中念珠菌血症的独立危险因素包括全胃肠外营养、急性肾损伤、心脏病、既往感染性休克和氨基糖苷类抗生素暴露。非 ICU 人群念珠菌血症的独立危险因素包括中心静脉导管、全肠外营养以及糖肽和硝基咪唑暴露。基于这些风险因素的评分在 ICU 中的准确性优于非 ICU 人群。念珠菌病患者死亡的独立危险因素包括感染性休克、急性肾损伤、以及患者在念珠菌血症之前接触的抗生素数量。讨论 虽然这项研究显示了已知和新的念珠菌血症危险因素的作用，但它特别强调了根据医院环境（ICU 与非 ICU）它们分布的重要差异。结论 本研究为考虑医院环境以及患者管理策略和真菌流行病学的最新进展提供了新的念珠菌血症风险评分。