Early diagnosis of candidiasis in non-neutropenic critically ill patients

• Published in: The Journal of infection 2004-02, Vol.48 (2), p.181-192
• Main Authors: Ibàñez-Nolla, J, Nolla-Salas, M, León, M.A, Garcı́a, F, Marrugat, J, Soria, G, Dı́az, R.M, Torres-Rodrı́guez, J.M
• Format: Article
• Language: English
• Subjects: Antifungal Agents - therapeutic use; Biological and medical sciences; Candida albicans; Candida albicans - growth & development; Candida glabrata; Candidiasis - diagnosis; Candidiasis - drug therapy; Candidiasis - microbiology; Candidiasis - mortality; Cohort Studies; Critical Care; Critical Illness; Diagnosis; Female; Guidelines as Topic; Hematologic and hematopoietic diseases; Humans; Infectious diseases; Invasive candidiasis; Male; Medical sciences; Middle Aged; Mortality; Multifocal candidiasis; Non- Candida albicans; Non-neutropenic; Other diseases. Hematologic involvement in other diseases; Prospective Studies; Risk Factors; Severity of Illness Index
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1016/S0163-4453(03)00120-8

Objective. To determine a method for the early diagnosis of candidiasis in non-neutropenic critically ill patients in order to reduce mortality. Methods. A prospective study in non-neutropenic critically patients in whom Candida spp. were detected, was made in an intensive care unit (ICU) during an 8-year period from 3389 patients admitted. A diagnostic and therapeutic protocol was designed. Invasive candidiasis was defined according to dissemination and multifocality. Results. Candida spp. were found in 145 cases (4,3%): 120 (83%) were considered as invasive candidiasis and 25 as colonisation (17%). The hospital mortality was 46% (67/145). A post-mortem study was carried out in 54% (36/67) of hospital deaths. Candida albicans was the most frequently isolated species (87%), followed by Candida glabrata (18%). There were 24 candidemias and three cases of endophtalmitis. Digestive and respiratory samples and non- C. albicans yeasts were risk factors for invasive candidiasis. The mortality rate was related statistically to invasive candidiasis and inversely to the appropriate antifungal treatment. Conclusions. Invasive candidiasis is related to digestive and respiratory samples and to the presence of non- C. albicans species. A simpler definition of invasive candidiasis in non-neutropenic critically ill patients will permit more rapid and accurate specific antifungal therapy.