Risk factors for Candida colonization/infection in non-neutropenic medical critically ill patients

Background

To evaluate the risk factors of Candida colonization/infection in the non-neutropenic medical critically ill patients (pts) who were admitted to ICUs.

Methods

Prospective observational multicenter study from May 1998–January 1999 in pts staying ≥ 7 days in 73 Spanish intensive care units (ICU). Surveillance cultures were performed weekly from: tracheal aspirates, urine, and gut (oropharynx ± gastric aspirates). The pts were catalogued in two groups: colonized (appearance or persistence of Candida in surveillance cultures) and invasive candidiasis (IC) (defined as any one or more of the conditions following: candidemia, endophtalmitis, other infections: peritonitis, organ biopsy). Multisite colonization (MC) was defined as ≥ 2 sites positive from surveillance cultures, and persistent MC as positive cultures in ≥ 1 week. The pts were clasified in two groups, medical, and surgical-traumatic. Demographic variables, APACHE II, comorbidity, associated risk factors and outcome were analized and compared between the two groups.

Results

We analyzed 1765 consecutive pts: 961 were considered colonized or infected by Candida species: 468 were medical, 309 surgical and 184 traumatic pts. In the medical group 438 were colonized (persistent MC, 78 pts; non-persistent MC, 183 pts; and in a single site, 202 pts, and 30 (6.4%) were in IC group. C. albicans was the most prevalent (82.4%). Univariate analysis identified factors to be associated with Candida colonization/infection in the medical pts: age, APACHE II, diabetes, COPD, hematologic malignancies, renal insufficiency, immunosupression, steroid therapy time, and mortality rate (intra-ICU and hospital). By stepwise logistic regression, hematologic malignancies (OR 6.0 [95% CI, 1.1-31.4]), diabetes (OR 2.4 [95% CI, 1.4-4.2]), and enteral nutrition (OR 2.2 [95% CI, 1.4-3.6]), proved to predict the development of Candida presence in medical pts independently.

Conclusions

Hematologic malignancies, diabetes and enteral nutrition are independently significant risk factors for Candida colonization/infection in medical critically ill patients.