Outcome and potentially modifiable risk factors for candidemia in critically ill burns patients: A matched cohort study (original) (raw)
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Invasive Candidiasis in Hospitalized Patients with Major Burns
Journal of Personalized Medicine
Background: Invasive candidiasis (IC) is a major cause of morbidities and mortality in patients hospitalized with major burns. This study investigated the incidence of IC in this specific population and analyzed the possible risk factors. Materials and Methods: We retrospectively analyzed data from the National Health Insurance Research Database (NHIRD) of Taiwan. We identified 3582 patients hospitalized with major burns on over 20% of their total body surface area (TBSA) during 2000–2013; we further analyzed possible risk factors. Result: IC was diagnosed in 452 hospitalized patients (12.6%) with major burns. In the multivariate analysis, patients older than 50 years (adjusted odds ratio (OR) = 1.96, 95% confidence interval (CI) 1.36–2.82), those of female sex (adjusted OR = 1.33, 95% CI 1.03–1.72), those with burns on the head (adjusted OR = 1.33, 95% CI 1.02–1.73), and those with burns over a greater TBSA had higher risks of IC. Conclusion: Treating IC is crucial in healthcare fo...
Candida infection in severe burns
Burns, 1985
Candida infection has become an important cause of morbidity and death in burned or immunosuppressed patients. Two patients with extensive bums complicated with Candida infection are presented, along with the risk factors, diagnostic procedures, and current methods of treatment.
Management of candida septicaemia in a regional burn unit
Burns, 1995
Sepsis due to candida infection is a major cause of mortality and morbidity on our unit. Over a period of 3 years and 4 months, 29 cases of candida seplicaemia, diagnosed by blood cultures, were encountered at the burn unit at Augusta Regional Medical Center. Factors known to predispose to fungal sepsis were present in all cases. All patients had large burns (14-98 per cent total body surface (TBSA) with a mean of 48.3 per cent}. All but one patient had at least one central venous line. Respiratoy problems requiring ventilator support were presenf in 24 patients. Sixteen patients had Candida albicans sepsis, two in association wifh anotherfungal sepsis. Candida parapsilosis was encountered in nine patients, one in combination wifh another species. Four pafienfs had Candida tropicalis. Amphotericin B was prescribed fherupeuticully in 25 patients, in seven together withfluconazole. Two pnfienfs receivedfluconazole only and fwo received no antifungal therapy. There were eight deaths all atfribufed to sepsis and all of whom had multiple organ failure. Five of those who died had completed a course of amphotwicin B therapy, Iwo were receiving treatment at the time of death, and one patienf died before culture data became available. Eurly and aggressive therapy is advised and amphofericin B appears to be fhe drug of choice.
Clinical Microbiology and Infection, 2009
A matched case-control study was conducted to determine the risk factors for development of candidaemia in patients requiring intensive-care unit (ICU) treatment for more than 48 h. Patients were matched according to length of ICU stay, age, department of admission, year of admission and sex. Forty-five patients with candidaemia were identified (0.6 cases/1000 patient-days). Candidaemia developed mainly in critically ill patients with multiple organ failure and end-stage disease. Candida colonization and gastrointestinal surgery were independently associated with candidaemia. ICU and total in-hospital mortality were 40% and 66.7%, respectively. Candidaemia-related mortality was 20%.
ESICM/ESCMID task force on practical management of invasive candidiasis in critically ill patients
Intensive Care Medicine, 2019
Introduction: The term invasive candidiasis (IC) refers to both bloodstream and deep-seated invasive infections, such as peritonitis, caused by Candida species. Several guidelines on the management of candidemia and invasive infection due to Candida species have recently been published, but none of them focuses specifically on critically ill patients admitted to intensive care units (ICUs). Material and Methods: In the absence of available scientific evidence, the resulting recommendations are based solely on epidemiological and clinical evidence in conjunction with expert opinion. The task force used the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach to evaluate the recommendations and assign levels of evidence. The recommendations and their strength were decided by consensus and, if necessary, by vote (modified Delphi process). Descriptive statistics were used to analyze the results of the Delphi process. Statements obtaining > 80% agreement were considered to have achieved consensus. Conclusions: The heterogeneity of this patient population necessitated the creation of a mixed working group comprising experts in clinical microbiology, infectious diseases and intensive care medicine, all chosen on the basis of their expertise in the management of IC and/or research methodology. The working group's main goal was to provide clinicians with clear and practical recommendations to optimize microbiological diagnosis and treatment of IC. The Systemic Inflammation and Sepsis and Infection sections of the European Society of Intensive Care Medicine (ESICM) and the Critically Ill Patients Study Group of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) therefore decided to develop a set of recommendations for application in non-immunocompromised critically ill patients.
Potential risk factors for infection with Candida spp. in critically ill patients
Clinical Microbiology and Infection, 2004
The incidence, risk factors and prognostic factors for candidal infection were determined in a prospective study of 280 infected patients. Thirty-one (11%) patients were infected with Candida spp., sub-divided into 18 (58%) with C. albicans, and 13 (42%) with non-albicans spp. (six C. glabrata, three C. parapsilosis, and one each of C. krusei, C. tropicalis, C. guilliermondii and C. lusitaniae). Infection with Candida spp. was always associated with concurrent bacterial infection. By univariate logistic regression analysis, the degree of morbidity and the duration of mechanical ventilation were independent predictive factors for death, but infection with Candida spp., was not. Factors associated with Candida spp. infection were the degree of morbidity, intensive care unit length of stay, alterations of immune response, and the number of medical devices involved. By multivariate logistic regression analysis, the only independent risk factor for candidal infection was intensive care unit length of stay.
Acta bio-medica : Atenei Parmensis, 2018
Invasive candidiasis management through the rapid initiation of appropriate antifungal therapy has been shown to be associated with the better prognosis, improved clinical outcome and reduced mortality in critically ill patients. Therefore, selection of an appropriate antifungal therapy should be based on the distribution of candida species and the pattern of antifungal resistance. This study aimed to assess the prevalence of candidemia and associated subtypes following severe sepsis in non-neutropenic critically ill patients. This study was a cross-sectional study that was conducted on severe sepsis patients stayed at least seven days in intensive care unit. Patients less than 18 years old, pregnant and breastfeeding patients, immunocompromised patients, neutropenic patients, patients with concurrent use of antifungal medicines and cytotoxic agents were excluded.To asses the candidemia, one mililiter of patients' blood sample was collected. Sample analysis was performed by Rea...