Prognostic factors and historical trends in the epidemiology of candidemia in critically ill patients: an analysis of five multicenter studies sequentially conducted over a 9-year period

• DOI: 10.1007/s00134-014-3400-y
• Publication Date: 2014-07-31T03:03:55Z
• Authors: Arnaldo L. Colombo; Thais Guimarães; Teresa Sukienik; Alessandro C. Pas...; Ricardo Andreotti; Flavio Queiroz-Te...; Simone A. Nouér; Marcio Nucci
• Keywords: Adult; Male; Cholagogues and Choleretics; Antifungal Agents; Adolescent; Original; Critical Illness; 610; Critical Care and Intensive Care Medicine; Echinocandins; 03 medical and health sciences; Humans; Multicenter Studies as Topic; Echinocandin; Hospital Mortality; Mortality; Antifungal therapy; Aged; Aged, 80 and over; 0303 health sciences; Candidemia; Middle Aged; Prognosis; 3. Good health; Invasive candidiasis; Intensive Care Units; Multivariate Analysis; Female; Brazil; Deoxycholic Acid

To describe temporal trends in the epidemiology, clinical management and outcome of candidemia in intensive care unit (ICU) patients.This study was a retrospective analysis of 1,392 episodes of candidemia in 647 adult ICU patients from 22 Brazilian hospitals. The characteristics of candidemia in these ICU patients were compared in two periods (2003-2007, period 1; 2008-2012, period 2), and the predictors of 30-day mortality were assessed.The proportion of patients who developed candidemia while in the ICU increased from 44 % in period 1 to 50.9 % in period 2 (p = 0.01). Prior exposure to fluconazole before candidemia (22.3 vs. 11.6 %, p < 0.001) and fungemia due to Candida glabrata (13.1 vs. 7.8 %, p = 0.03) were more frequent in period 2, as was the proportion of patients receiving an echinocandin as primary therapy (18.0 vs. 5.9 %, p < 0.001). The 30-day mortality rate decreased from 76.4 % in period 1 to 60.8 % in period 2 (p < 0.001). Predictors of 30-day mortality by multivariate analysis were older age, period 1, treatment with corticosteroids and higher APACHE II score, while treatment with an echinocandin were associated with a higher probability of survival.We found a clear change in the epidemiology and clinical management of candidemia in ICU patients over the 9-year period of the study. The use of echinocandins as primary therapy for candidemia appears to be associated with better outcomes.