Fungal colonization and infection in critically ill patients

Objective

To determine the incidence of fungal colonization and infection in critically ill patients.

Methods

It is a prospective study during 30 months of the patients admitted to the ICU during 24 hours or more. A throat swab, tracheal aspirate and urine samples were taken on admission and twice weekly. The fungal colonization and infection were registered. Infections were diagnosed according to CDC criteria. Infections were classified based on throat flora as: primary endogenous (PE) when caused by germs that were already colonizing the throat on ICU admission; secondary endogenous (SE) when caused by germs that were not colonizing the throat on the ICU admission but were acquired during the stay in ICU; exogenous (EX) when caused by germs that were not colonizing the throat. Infections were classified based on the onset moment as: early onset (EO) (developed during the first 4 days of ICU stay) and late onset (LO) (developed 5 days after ICU admission).

Results

A total 1582 patients were admitted, 953 males (60.24%). Mean age was 57.91 ± 18.83 years. Mean APACHE II score was 13.95 ± 8.93. Admission diagnoses were: 737 (46.59%) heart surgery, 189 cardiological (11.95%), 196 neurologic (12.29%), 185 trauma (11.69%), 120 respiratory (7.59%), 104 digestive (6.57%) and 51 intoxication (3.22%). Mortality rate was 14.79% (234 patients). A total of 154 patients had fungal colonization, 40 patients at ICU admission and 114 patients during the ICU stay. Forty-eight fungal infections were documented (eight EO and 40 LO; four PE, 40 SE and four EX): 19 urinary tract infections (three EO and 16 LO; three PE, 13 SE and three EX), 12 pneumonias (two EO and 10 LO; one PE, 10 SE and one EX), nine primary fungemias (two EO and seven LO; nine SE), six surgical wounds (one EO and five LO; six SE) and two pressure sores (0 EO and two LO; two SE). The 48 fungi responsible for 48 fungal infections were: 29 Candida albicans, 12 Candida tropicalis, four Candida glabrata, two Candida parapsilopsis, one Candida famata. Death occurred in 12/48 patients (25%) with fungal infection: 3/9 (33.33%) fungemias, 5/12 (41.66%) pneumonias and 4/27 (14.81%) other infections.

Conclusions

Most fungal infections had a late onset, were secondary endogenous and were due to C. albicans. The urinary tract was the more frequent origin.