Risk factors of candidemia in postoperative ICU patients: a prospective study

Introduction

The prediction for and the mortality of patients with candidemia are highly adverse. The aim of this study was to identify the risk factors for the development of candidemia in postoperative patients.

Methods

From 1 July 2010 to 30 June 2013 all postoperative patients (n = 588) admitted to the multivalent ICU of our hospital were enrolled in this study. We recorded the age, sex, length of stay in the ICU, APACHE II score upon admission to the ICU, adjusted mortality score, underlying conditions, recent operations, invasive therapeutic procedures and prior usage of antimicrobial agents. Initial bivariable statistical comparisons were conducted using the x² test for categorical data and the Student t test or Wilcoxon test for continuous data. Relative risks (RRs) and their 95% confidence intervals (CIs) were calculated. Statistical significance was set at P < 0.05. To identify patient characteristics associated with candidemia we used multivariable logistic regression. In the multivariant analysis we also included the independent risk factors reported in recent medical literature. Results of the logistic regression analysis are reported as adjusted odds ratio (OR) with 95% CI.

Results

Out of 588 patients, 30 (5.1%) developed candidemia (frequency: 12 per 1,000 days of hospitalization). The mortality of patients with candidemia was 66.7% (20/30). The monovariant analysis showed statistical significant difference in the following factors: immunosuppression (P = 0.0005), diabetes mellitus (P = 0.0005), hypoproteinemia (P = 0.0005), the presence of central venous catheter (P = 0.0005), the coexistence of bacteremia and the prior use of antimicrobial agents (P = 0.0005), length of stay in the ICU >5 days (P = 0.004) and the type of intervention (P = 0.001). As independent risk factors from the multivariant analysis were found the following: immunosuppression (exp(B) = 218.37, 95% CI = 11.76 to 4,053.72, P = 0.0005), hypoproteinemia (exp(B) = 25.69, 95% CI = 2.82 to 296.8, P = 0.009), presence of central venous catheter (exp(B) = 13.79, 95% CI = 1.86 to 102.51, P = 0.01) and the coexistence of bacteremia in combination with prior use of antimicrobial agents (exp(B) = 404.94, 95% CI = 11.61 to 14190.41, P = 0.001).

Conclusion

Early candidemia identification, prompt collaboration of intensivists with biopathologists and immediate initiation of the proper antifungal treatment is of great significance. The concurrent understanding of the predisposing risk factors constitutes a significant supportive tool for the prediction of such infections.