Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005-2006)
| Autor: | Leroy , Olivier, Gangneux , Jean-Pierre, Montravers , Philippe, Mira , Jean-Paul, Gouin , François, Sollet , Jean-Pierre, Carlet , Jean, Reynes , Jacques, Rosenheim , Michel, Regnier , Bernard, Lortholary , Olivier, Renseigné , Non |
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| Přispěvatelé: | Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Gustave Dron, Signalisation et Réponses aux Agents Infectieux et Chimiques ( SeRAIC ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -IFR140, Régulations des équilibres fonctionnels du foie normal et pathologique, Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -IFR140-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Département anesthésie-réanimation chirurgicale, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Institut Cochin ( UMR_S567 / UMR 8104 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Université de Nantes ( UN ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre hospitalier universitaire de Nantes ( CHU Nantes ), service de réanimation polyvalente, Centre Hospitalier Victor Dupuy, Réanimation Médico-Chirurgicale, Groupe Hospitalier Paris Saint-Joseph, Centre d'infectiologie Necker-Pasteur [CHU Necker], CHU Necker - Enfants Malades [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP), Mycologie moléculaire, Institut Pasteur [Paris]-Centre National de la Recherche Scientifique ( CNRS ), Signalisation et Réponses aux Agents Infectieux et Chimiques (SeRAIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Cochin (UMR_S567 / UMR 8104), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Physiopathologie des Adaptations Nutritionnelles (PhAN), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre hospitalier universitaire de Nantes (CHU Nantes), Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA)-Université de Nantes (UN), Groupe Hospitalier Paris Saint-Joseph (hpsj), Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-IFR140, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-IFR140-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Necker - Enfants Malades [AP-HP], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1) |
| Jazyk: | angličtina |
| Rok vydání: | 2009 |
| Předmět: |
Male
critically ill MESH : Aged MESH : Prospective Studies Critical Care and Intensive Care Medicine 0302 clinical medicine Case fatality rate Hospital Mortality Prospective Studies MESH: Incidence Fungemia MESH: Treatment Outcome Cause of death Aged 80 and over Cross Infection 0303 health sciences MESH: Middle Aged Incidence Candidiasis MESH: Follow-Up Studies MESH : Incidence 3. Good health Survival Rate [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology MESH: Young Adult MESH: Critical Illness MESH : Intensive Care Units MESH : Cross Infection medicine.medical_specialty MESH: Probability Critical Illness MESH : Young Adult MESH : Cohort Studies Statistics Nonparametric MESH : Hospital Mortality 03 medical and health sciences MESH: Critical Care MESH: Fungemia Intensive care MESH : Adolescent Humans MESH : Middle Aged MESH: Hospital Mortality MESH : Aged 80 and over Mycosis Aged MESH: Adolescent MESH: Humans 030306 microbiology MESH : Humans MESH: Adult MESH : Follow-Up Studies MESH: Antifungal Agents medicine.disease chemistry MESH: Female Fluconazole Antifungal Agents MESH : Critical Illness Cohort Studies MESH: Cause of Death chemistry.chemical_compound MESH : Candidiasis MESH: Aged 80 and over Risk Factors MESH: Risk Factors [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology Cause of Death MESH : Female 030212 general & internal medicine MESH: Cohort Studies MESH : Critical Care Candida intensive care MESH: Aged MESH: Statistics Nonparametric fungemia Middle Aged MESH : Adult MESH : Survival Rate MESH : Risk Factors MESH: Candidiasis Intensive Care Units Treatment Outcome Female epidemiology France medicine.drug Adult Adolescent Critical Care MESH: Survival Rate MESH : Male MESH : Probability MESH : Antifungal Agents MESH : Treatment Outcome Young Adult Internal medicine medicine MESH : France MESH : Statistics Nonparametric Probability MESH : Cause of Death Voriconazole business.industry MESH: Cross Infection MESH: Male MESH: Prospective Studies Surgery MESH: France MESH : Fungemia MESH: Intensive Care Units Caspofungin business Follow-Up Studies |
| Zdroj: | Critical Care Medicine Critical Care Medicine, Lippincott, Williams & Wilkins, 2009, 37 (5), pp.1612-8. 〈10.1097/CCM.0b013e31819efac0〉 Critical Care Medicine, Lippincott, Williams & Wilkins, 2009, 37 (5), pp.1612-8. ⟨10.1097/CCM.0b013e31819efac0⟩ Critical Care Medicine, 2009, 37 (5), pp.1612-8. ⟨10.1097/CCM.0b013e31819efac0⟩ |
| ISSN: | 0090-3493 1530-0293 |
| DOI: | 10.1097/CCM.0b013e31819efac0〉 |
| Popis: | International audience; OBJECTIVE: To describe the evolving epidemiology, management, and risk factors for death of invasive Candida infections in intensive care units (ICUs). DESIGN: Prospective, observational, national, multicenter study. SETTING: One hundred eighty ICUs in France. PATIENTS: Between October 2005 and May 2006, 300 adult patients with proven invasive Candida infection who received systemic antifungal therapy were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: One hundred seven patients (39.5%) with isolated candidemia, 87 (32.1%) with invasive candidiasis without documented candidemia, and 77 (28.4%) with invasive candidiasis and candidemia were eligible. In 37% of the cases, candidemia occurred within the first 5 days after ICU admission. C. albicans accounted for 57.0% of the isolates, followed by C. glabrata (16.7%), C. parapsilosis (7.5%), C. krusei (5.2%), and C. tropicalis (4.9%). In 17.1% of the isolates, the causative Candida was less susceptible or resistant to fluconazole. Fluconazole was the empirical treatment most commonly introduced (65.7%), followed by caspofungin (18.1%), voriconazole (5.5%), and amphotericin B (3.7%). After identification of the causative species and susceptibility testing results, treatment was modified in 86 patients (31.7%). The case fatality ratio in ICU was 45.9% and did not differ significantly according to the type of episode. Multivariate analysis showed that factors independently associated with death in ICU were type 1 diabetes mellitus (odds ratio [OR] 4.51; 95% confidence interval [CI] 1.72-11.79; p = 0.002), immunosuppression (OR 2.63; 95% CI 1.35-5.11; p = 0.0045), mechanical ventilation (OR 2.54; 95% CI 1.33-4.82; p = 0.0045), and body temperature >38.2 degrees C (reference, 36.5-38.2 degrees C; OR 0.36; 95% CI 0.17-0.77; p = 0.008). CONCLUSIONS: More than two thirds of patients with invasive candidiasis in ICU present with candidemia. Non-albicans Candida species reach almost half of the Candida isolates. Reduced susceptibility to fluconazole is observed in 17.1% of Candida isolates. Mortality of invasive candidiasis in ICU remains high. |
| Databáze: | OpenAIRE |
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