Risk factors for candida blood stream infection in medical ICU and role of colonization--a retrospective study

• Published in: British journal of medical practitioners Vol. 6; no. 2; p. 7
• Main Authors: Patolia, Setu, Kennedy, Eneh, Zahir, Mehjabin, Patolia, Swati, Gulati, Neerja, Narendra, Dharani, Vadde, Rakesh, Pokharel, Saurav, Schmidt, Frances M, Enriquez, Danilo, Quist, Joseph
• Format: Journal Article
• Language: English
• Published: J M N Medical Education Ltd 01-06-2013
• Subjects: Candidiasis; Diagnosis; Drug therapy; Risk factors; United States
• ISSN: 1757-8515; 1757-8515

Candida blood stream infection (candidaemia) is one of the most serious hospital acquired infections with high morbidity and mortality rates in the Intensive Care Unit (ICU). A number of risk factors have been identified in a variety of studies. ICU patients are frequently colonised with Candida species. The role of Candida colonisation as a causal factor for candidaemia remains controversial. Our objective for the study was to evaluate the risk factors for candidaemia and to evaluate the role of colonisation to predict candidaemia. We evaluated a total of 1483 patients aged over 18 years who stayed in ICU for more than 7 days. We collected various data about risk factors for candidaemia. A total of 56 patients (3.77%) developed candidaemia. We collected demographic and risk factor data including Candida colonisation of the urinary and respiratory tract. Binary logistic regression with forward likelihood ratio method model was used to analyse these risk factors. In our study, total parenteral nutrition (odds ratio (OR)-3.274, 95% confidence interval (CI) 1.263-8.486), presence of central venous line (OR- 1.895, CI 1.032-3.478), previous or current antibiotic use (OR 3.268, CI 1.532-6.972), respiratory tract colonisation (OR 2.150, CI 1.078-4.289) and urinary tract colonisation (OR 3.508, CI 1.926-6.388) were significant risk factors for Candida blood stream infection (BSI). Based on the model, we calculated the candidaemia risk score and based on the receiver operative curve analysis, a score more than 2 would be associated with a higher risk of candidaemia. Candida species isolated in the respiratory tract or urine were similar to that found in Candida BSI (Kappa coefficient for agreement of 0.83 and 0.47 respectively). So, it can be concluded that Candida colonisation of the respiratory tract and/or urine is a significant risk factor for Candida BSI along with the other risk factors. Keywords: Candidemia, Risk factors, Central Venous line, Colonization. Abbreviations: ICU--intensive care unit, OR--odds ratio, CI--confidence interval, BSI--blood stream infection, HIV-- Human immunodeficiency virus, IDSA--Infectious Disease Society of America, COPD--Chronic obstructive pulmonary disease, DM--Diabetes Mellitus, ESRD--End stage renal disease, TPN--Total parenteral nutrition.