Candidemia Surveillance and Impact on Non-neutropenic Critically Ill Patients.

Autor:	Hall Zimmerman L; Department of Pharmaceutical Services, William Beaumont University Hospital, Royal Oak, USA., Dolman H; The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, USA.; Department of Surgery, Detroit Receiving Hospital, Detroit, USA., Faris J; Department of Pharmacy, Parkland Health and Hospital System, Dallas, USA., Park L; Department of Pharmacy, Detroit Receiving Hospital, Detroit, USA., Mynatt R; Department of Pharmacy, Detroit Receiving Hospital, Detroit, USA., Zimmerman WB; Department of Osteopathic Surgical Specialties, Michigan State University, East Lansing, USA., Baylor AE; The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, USA.; Department of Surgery, Detroit Receiving Hospital, Detroit, USA., Tyburski J; The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, USA.; Department of Surgery, Detroit Receiving Hospital, Detroit, USA., Wilson RF; The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, USA.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Nov 06; Vol. 16 (11), pp. e73155. Date of Electronic Publication: 2024 Nov 06 (Print Publication: 2024).
DOI:	10.7759/cureus.73155
Abstrakt:	Background: Candidemia is a common pathogen in critically ill patients and has a significant negative impact on morbidity and mortality. Risk factors linked with candidemia are reported in the literature. We evaluated the risk factors associated with candidemia in critically ill patients on mortality rates, including the impact of delayed or inadequate antifungal therapy (IAAT). Methods: This retrospective study evaluated non-neutropenic critically ill adult patients with candidemia for six consecutive years. Antifungal therapy was evaluated for the following: the correct dose based on the in vitro activity against Candida species identified on culture, the time interval from culture positivity to the initiation of antifungal therapy, and the duration of antifungal therapy. Adequate antifungal therapy (AAT) was defined as the initial antifungal agent administered to the patient with in vitro activity against Candida species identified on culture using the correct dose, time of initiation, and duration of therapy. IAAT was determined if the antifungal did not have in vitro activity against the  Candida species identified on culture with the initial incorrect dose. Results: In the 91 critically ill patients evaluated with documented candidemia, the mean age was 57±16 years, the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 25±9, and the overall mortality rate was 38%. Patients with the following risk factors for candidemia had an increased mortality: use of mechanical ventilation (35 (100%), p<0.001), vasopressor therapy (28 (80%), p<0.001), end-stage renal disease (ESRD) (11 (31%), p<0.001), and ≥ 2 organ failure (23 (65%), p=0.002). Mortality was also more likely in patients who received IAAT: 16 (64%) IAAT vs. 19 (29%) AAT, p=0.001. Conclusions: In critically ill patients with risk factors associated with candidemia, AAT is important when candidemia is suspected. This study found that  C. glabrata was more likely isolated in patients with ESRD, vasopressor therapy for hemodynamic support, high APACHE II scores, and ≥ 2 organ dysfunction. Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Wayne State University issued approval 108610MP4E. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Hall Zimmerman et al.)
Databáze:	MEDLINE
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