Risk factors for candidemia: a prospective matched case-control study
Julien Poissy,
Lauro Damonti,
Anne Bignon,
Nina Khanna,
Matthias Von Kietzell,
Katia Boggian,
Dionysios Neofytos,
Fanny Vuotto,
Valérie Coiteux,
Florent Artru,
Stephan Zimmerli,
Jean-Luc Pagani,
Thierry Calandra,
Boualem Sendid,
Daniel Poulain,
Christian van Delden,
Frédéric Lamoth,
Oscar Marchetti,
Pierre-Yves Bochud,
the FUNGINOS,
Allfun French Study Groups
Affiliations
Julien Poissy
Current affiliation : Univ. Lille, Inserm U1285, CHU Lille, Pôle de réanimation, NRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle
Lauro Damonti
Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne
Anne Bignon
Surgical Intensive Care Unit, University Hospital of Lille
Nina Khanna
Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital of Basel
Matthias Von Kietzell
Infectious Diseases Department, Cantonal Hospital of Saint Gallen
Katia Boggian
Infectious Diseases Department, Cantonal Hospital of Saint Gallen
Dionysios Neofytos
Transplant Infectious Diseases Unit, University Hospitals of Geneva
Fanny Vuotto
Infectious Diseases Department, University Hospital of Lille
Valérie Coiteux
Hematological Disorders Department, University Hospital and University of Lille
Florent Artru
Digestive Intensive Care Department, University Hospital and University of Lille
Stephan Zimmerli
Department of Infectious Diseases Department, Inselspital, Bern University Hospital, University of Bern
Jean-Luc Pagani
Adult Intensive Care Service, University Hospital and University of Lausanne
Thierry Calandra
Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne
Boualem Sendid
Inserm, U995-2 “Fungal Associated Invasive and Inflammatory Diseases”
Daniel Poulain
Inserm, U995-2 “Fungal Associated Invasive and Inflammatory Diseases”
Christian van Delden
Transplant Infectious Diseases Unit, University Hospitals of Geneva
Frédéric Lamoth
Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne
Oscar Marchetti
Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne
Pierre-Yves Bochud
Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne
Abstract Background Candidemia is an opportunistic infection associated with high morbidity and mortality in patients hospitalized both inside and outside intensive care units (ICUs). Identification of patients at risk is crucial to ensure prompt antifungal therapy. We sought to assess risk factors for candidemia and death, both outside and inside ICUs. Methods This prospective multicenter matched case-control study involved six teaching hospitals in Switzerland and France. Cases were defined by positive blood cultures for Candida sp. Controls were matched to cases using the following criteria: age, hospitalization ward, hospitalization duration, and, when applicable, type of surgery. One to three controls were enrolled by case. Risk factors were analyzed by univariate and multivariate conditional regression models, as a basis for a new scoring system to predict candidemia. Results One hundred ninety-two candidemic patients and 411 matched controls were included. Forty-four percent of included patients were hospitalized in ICUs, and 56% were hospitalized outside ICUs. Independent risk factors for candidemia in the ICU population included total parenteral nutrition, acute kidney injury, heart disease, prior septic shock, and exposure to aminoglycoside antibiotics. Independent risk factors for candidemia in the non-ICU population included central venous catheter, total parenteral nutrition, and exposure to glycopeptides and nitroimidazoles. The accuracy of the scores based on these risk factors is better in the ICU than in the non-ICU population. Independent risk factors for death in candidemic patients included septic shock, acute kidney injury, and the number of antibiotics to which patients were exposed before candidemia. Discussion While this study shows a role for known and novel risk factors for candidemia, it specifically highlights important differences in their distribution according to the hospital setting (ICU versus non-ICU). Conclusion This study provides novel risk scores for candidemia accounting for the hospital setting and recent progress in patients’ management strategies and fungal epidemiology.
