Early prediction of Candida glabrata fungemia in nonneutropenic critically ill patients.

Abstract

OBJECTIVE:

Candida species represent the fourth cause of nosocomial bloodstream infections worldwide. Because Candida glabrata has become the second most frequently identified yeast and because the rate of fluconazole-resistant C. glabrata strains reaches 10% to 15%, initial antifungal therapy based on fluconazole in nonneutropenic hemodynamically stable patients, as recommended by current guidelines, may be an ineffective option. Our aim was to determine easy-to-identify risk factors for C. glabrata fungemia likely to guide and improve initial antifungal therapy.

DESIGN:

Prospective multicenter cohort study.

SETTING:

Five French intensive care units.

PATIENTS:

Consecutive nonneutropenic patients without known Candida colonization who had blood culture-confirmed fungemia over a 4-yr period.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A total of 8206 patients were screened. One hundred fifty-four patients with blood culture-confirmed fungemia constituted the cohort, of whom 48 had C. glabrata fungemia and 106 had nonglabrata fungemia. Patients' baseline characteristics and in-intensive care unit events potentially related to C. glabrata fungemia were systematically recorded. Compared with patients with nonglabrata fungemia, patients with C. glabrata fungemia were older and more severely ill, had received more antibiotics, and were more likely to have undergone surgery. The stepwise logistic regression analysis identified six independent risk factors for C. glabrata fungemia: age >60 yrs, recent abdominal surgery, interval from intensive care unit admission to first positive blood culture <or=7 days, recent use of cephalosporins, solid tumor, and absence of diabetes mellitus. The model showed satisfying goodness of fit (Hosmer-Lemeshow statistic = .26) and discrimination (c statistic = .89).

CONCLUSIONS:

We found six early available and easy-to-identify risk factors for C. glabrata fungemia. When these factors are present, alternatives to fluconazole for initial antifungal therapy should be considered.

• Authors: Yves Cohen, Philippe Karoubi, Christophe Adrie, Rémy Gauzit, Thierry Marsepoil, Daniel Zarka, Christophe Clec'h
• Journal: Critical care medicine (Crit Care Med) Vol. 38 Issue 3 Pg. 826-30 (Mar 2010) ISSN: 1530-0293 [Electronic] United States
• PMID: 20042858 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Antifungal Agents
• Fluconazole

Topics

• Adult
• Aged
• Antifungal Agents (therapeutic use)
• Candida glabrata (drug effects)
• Candidiasis (diagnosis, drug therapy, epidemiology)
• Cohort Studies
• Critical Care
• Critical Illness
• Cross Infection (diagnosis, drug therapy, epidemiology)
• Cross-Sectional Studies
• Female
• Fluconazole (therapeutic use)
• France
• Fungemia (diagnosis, drug therapy, epidemiology)
• Hospitals, University
• Humans
• Incidence
• Intensive Care Units
• Male
• Mass Screening
• Middle Aged
• Neutropenia (diagnosis, drug therapy, epidemiology)
• Opportunistic Infections (diagnosis, drug therapy, epidemiology)
• Prospective Studies
• Risk Factors