Candida crical care

Candida bloodstream infections in intensive care units: Analysis of the extended prevalence of infection in intensive care unit study*
Daniel H. Kett, MD; Elie Azoulay, MD, PhD; Pablo M. Echeverria, MD; Jean-Louis Vincent, MD, PhD, FCCM; and for the Extended Prevalence of Infection in the ICU Study (EPIC II) Group of Investigators
Objectives: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. Design: A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge. Setting: EPIC II included 1265 intensive care units in 76 countries. Patients: Patients in participating intensive care units on study day. Interventions: None. Measurement and Main Results: Of the 14,414 patients in EPIC II, 99 patients had Candida bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstream infections. Candida albicans (n 70) was the predominant species. Primary therapy included monotherapy with fluconazole (n 39), caspofungin (n 16), and a polyene-based product (n 12). Combination therapy was infrequently used (n 10). Compared with patients with Gram-positive (n 420) and Gram-negative (n 264) bloodstream infections, patients with candidemia were more likely to have solid tumors (p < .05) and appeared to have been in an intensive care unit longer (14 days [range, 5–25 days], 8 days [range, 3–20 days], and 10 days [range, 2–23 days], respectively), but this difference was not statistically significant. Severity of illness and organ dysfunction