Characteristics and risk factors for 28-day mortality of hospital acquired fungemias in ICUs: data from the EUROBACT study

Paiva, Jose-Artur, Pereira, Jose Manuel, Tabah, Alexis, Mikstacki, Adam, de Carvalho, Frederico Bruzzi, Koulenti, Despoina, Ruckly, Stephane, Cakar, Nahit, Misset, Benoit, Dimopoulos, George, Antonelli, Massimo, Rello, Jordi, Ma, Xiaochun, Tamowicz, Barbara and Timsit, Jean-Francois (2016) Characteristics and risk factors for 28-day mortality of hospital acquired fungemias in ICUs: data from the EUROBACT study. Critical Care, 20 . doi:10.1186/s13054-016-1229-1


Author Paiva, Jose-Artur
Pereira, Jose Manuel
Tabah, Alexis
Mikstacki, Adam
de Carvalho, Frederico Bruzzi
Koulenti, Despoina
Ruckly, Stephane
Cakar, Nahit
Misset, Benoit
Dimopoulos, George
Antonelli, Massimo
Rello, Jordi
Ma, Xiaochun
Tamowicz, Barbara
Timsit, Jean-Francois
Title Characteristics and risk factors for 28-day mortality of hospital acquired fungemias in ICUs: data from the EUROBACT study
Journal name Critical Care   Check publisher's open access policy
ISSN 1466-609X
1364-8535
Publication date 2016-03-09
Year available 2016
Sub-type Article (original research)
DOI 10.1186/s13054-016-1229-1
Open Access Status DOI
Volume 20
Total pages 13
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2017
Language eng
Formatted abstract
Background: To characterize and identify prognostic factors for 28-day mortality among patients with hospital-acquired fungemia (HAF) in the Intensive Care Unit (ICU).

Methods: A sub-analysis of a prospective, multicenter non-representative cohort study conducted in 162 ICUs in 24 countries.

Results: Of the 1156 patients with hospital-acquired bloodstream infections (HA-BSI) included in the EUROBACT study, 96 patients had a HAF. Median time to its diagnosis was 20 days (IQR 10.5-30.5) and 9 days (IQR 3-15.5) after hospital and ICU admission, respectively. Median time to positivity of blood culture was longer in fungemia than in bacteremia (48.7 h vs. 38.1 h; p = 0.0004). Candida albicans was the most frequent fungus isolated (57.1 %), followed by Candida glabrata (15.3 %) and Candida parapsilosis (10.2 %). No clear source of HAF was detected in 33.3 % of the episodes and it was catheter-related in 21.9 % of them. Compared to patients with bacteremia, HAF patients had a higher rate of septic shock (39.6 % vs. 21.6 %; p = 0.0003) and renal dysfunction (25 % vs. 12.4 %; p = 0.0023) on admission and a higher rate of renal failure (26 % vs. 16.2 %; p = 0.0273) at diagnosis. Adequate treatment started within 24 h after blood culture collection was less frequent in HAF patients (22.9 % vs. 55.3 %; p < 0.001). The 28-day all cause fatality was 40.6 %. According to multivariate analysis, only liver failure (OR 14.35; 95 % CI 1.17-175.6; p = 0.037), need for mechanical ventilation (OR 8.86; 95 % CI 1.2-65.24; p = 0.032) and ICU admission for medical reason (OR 3.87; 95 % CI 1.25-11.99; p = 0.020) were independent predictors of 28-day mortality in HAF patients.

Conclusions: Fungi are an important cause of hospital-acquired BSI in the ICU. Patients with HAF present more frequently with septic shock and renal dysfunction on ICU admission and have a higher rate of renal failure at diagnosis. HAF are associated with a significant 28-day mortality rate (40 %), but delayed adequate antifungal therapy was not an independent risk factor for death. Liver failure, need for mechanical ventilation and ICU admission for medical reason were the only independent predictors of 28-day mortality.
Keyword Fungemia
Hospital-acquired bloodstream infections
HA-BSI
Hospital-acquired fungemia
HAF
Septic
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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