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01.06.2014 | Original | Ausgabe 6/2014

Intensive Care Medicine 6/2014

A multicenter study of septic shock due to candidemia: outcomes and predictors of mortality

Zeitschrift:
Intensive Care Medicine > Ausgabe 6/2014
Autoren:
Matteo Bassetti, Elda Righi, Filippo Ansaldi, Maria Merelli, Trucchi Cecilia, Gennaro De Pascale, Ana Diaz-Martin, Roberto Luzzati, Chiara Rosin, Leonel Lagunes, Enrico Maria Trecarichi, Maurizio Sanguinetti, Brunella Posteraro, Jose Garnacho-Montero, Assunta Sartor, Jordi Rello, Giorgio Della Rocca, Massimo Antonelli, Mario Tumbarello
Wichtige Hinweise
Take-home message: High mortality rates were confirmed in patients with Candida-induced septic shock. In this group, the administration of an adequate antifungal therapy along with adequate source control are key factors to improve clinical outcomes.
An erratum to this article can be found at http://​dx.​doi.​org/​10.​1007/​s00134-014-3387-4.

Abstract

Purpose

Candida is the most common cause of severe yeast infections worldwide, especially in critically ill patients. In this setting, septic shock attributable to Candida is characterized by high mortality rates. The aim of this multicenter study was to investigate the determinants of outcome in critically ill patients with septic shock due to candidemia.

Methods

This was a retrospective study in which patients with septic shock attributable to Candida who were treated during the 3-year study period at one or more of the five participating teaching hospitals in Italy and Spain were eligible for enrolment. Patient characteristics, infection-related variables, and therapy-related features were reviewed. Multiple logistic regression analysis was performed to identify the risk factors significantly associated with 30-day mortality.

Results

A total of 216 patients (mean age 63.4 ± 18.5 years; 58.3 % males) were included in the study. Of these, 163 (75 %) were admitted to the intensive care unit. Overall 30-day mortality was 54 %. Significantly higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, dysfunctional organs, and inadequate antifungal therapy were compared in nonsurvivors and survivors. No differences in survivors versus nonsurvivors were found in terms of the time from positive blood culture to initiation of adequate antifungal therapy. Multivariate logistic regression identified inadequate source control, inadequate antifungal therapy, and 1-point increments in the APACHE II score as independent variables associated with a higher 30-day mortality rate.

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