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01.03.2009 | Article | Ausgabe 3/2009

European Journal of Clinical Microbiology & Infectious Diseases 3/2009

Fungal colonization and/or infection in non-neutropenic critically ill patients: results of the EPCAN observational study

Zeitschrift:
European Journal of Clinical Microbiology & Infectious Diseases > Ausgabe 3/2009
Autoren:
C. León, F. Álvarez-Lerma, S. Ruiz-Santana, M. Á. León, J. Nolla, R. Jordá, P. Saavedra, M. Palomar, The EPCAN Study Group
Wichtige Hinweise
The results of the present study had been presented in part at the 39th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), San Francisco, CA, September 1999; the 40th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), Toronto, Canada, September 2000; the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), Chicago, IL, December 2001; the 12th Annual Congress of the European Society of Intensive Care Medicine (ESICM), Berlin, Germany, October 1999; the 13th Annual Congress of the European Society of Intensive Care Medicine (ESICM), Rome, Italy, October 2000; the 14th Annual Congress of the European Society of Intensive Care Medicine (ESICM), Geneva, Switzerland, October 2001; the 15th Annual Congress of the European Society of Intensive Care Medicine (ESICM), Barcelona, Spain, September/October 2002; and the 21st International Symposium on Intensive Care and Emergency Medicine.(ICM), Brussels, Belgium, March 2001.

Final approval of the article

Cristóbal León, Francisco Álvarez-Lerma, María Ángeles León, Joan Nolla, Ricard Jordà, Sergio Ruiz-Santana, Pedro Saavedra.

Members of the EPCAN Study Group

J. Nolla, F. Álvarez-Lerma, M. Salvadó (Hospital del Mar, Barcelona); N. Carrasco, A. Bueno (Hospital de la Princesa, Madrid); F. Bobillo, P. Ucio (Hospital Clínico, Valladolid); M.A. León, M. Nolla, R.A. Díaz (Hospital General de Cataluña, Barcelona); J.R. Iruretagoyena, K. Esnaola, I. Andetxaga (Hospital de Cruces, Bilbao); A. Blanco, F. Taboada, R. Fernández (Hospital Nuestra Señora de Covadonga, Oviedo); M. Nieto, R. Diego, F. Ortuño (Hospital Clínico San Carlos, Madrid); P. Marcos, E. Mesalles (Hospital Germans Trias i Pujol, Badalona, Barcelona); A. Martínez, M. Fernández, F. Jaime (Hospital Virgen de la Arrixaca, Murcia); H. Sancho, N. Izquierdo (Hospital Reina Sofía, Córdoba); M. Ulibarrena, F. Labayen (Hospital Santiago Apóstol, Vitoria); F. Barcenilla, M.J. Gil, B. Balsera (Hospital Arnau de Villanova, Lleida); R. Jordá, M. Jurado, J. Pérez (Hospital Son Dureta, Palma de Mallorca); E. Zavala, A. Alcón, N. Fabregues (Hospital Clínic i Provincial, Barcelona); M.V. de la Torre, M.A. Estecha, A. Soler (Hospital Virgen de la Victoria, Málaga); M. Bodí, D. Castander (Hospital Joan XXIII, Tarragona); A. Mendía, J. Artaetxebarría, C. Reviejo (Hospital Nuestra Señora de Aránzazu, San Sebastián); M. Sánchez, A. Casamitjana, C. Pérez (Hospital Insular, Las Palmas de Gran Canaria); M.J. López, E. Robles (Hospital General de Segovia, Segovia); Y. Insausti, J.A. Tihistsa (Hospital de Navarra, Pamplona); C. García, J.M. Rubio (Hospital 12 de Octubre, Madrid); R. Oltra, O. Rodríguez (Hospital Clínico Universitario, Valencia); P. Olaechea, R. de Celís (Hospital de Galdakao, Bizkaia); J.M. Soto, J. Pomares (Hospital San Cecilio, Granada); J. Luna, G. Masdeu (Hospital Virgen de la Cinta, Tarragona); R. Sierra, A. Gordillo (Hospital Puerta del Mar, Cádiz); R. Rodríguez, J. Fajardo (Hospital Virgen de la Macarena, Sevilla); M.A. Herranz, J.I. Gómez (Hospital Río Hortega, Valladolid); R.M. García, M.J. Espina (Hospital de Cabueñes, Gijón); J. Garnacho, C. Ortiz (Hospital Virgen del Rocío, Sevilla); M. Palomar, J. Montero (Hospital Vall d’Hebron, Barcelona); C. Cisneros, A. Sandiumenje (UCI de Traumatología, Hospital 12 de Octubre, Madrid); M. Sánchez, M. Álvarez (Hospital Príncipe de Asturias, Madrid); V. López, R. Julve (Hospital de Sagunto, Valencia); J. Solé, M. Valerón (Hospital Nuestra Señora del Pino, Las Palmas de Gran Canaria); M.A. Blasco, S. Borrás (Hospital Dr. Peset, Valencia); E. Maraví, J.M. Urtasun (Hospital Virgen del Camino, Pamplona); C. Sánchez-Díaz (Hospital San Pedro de Alcántara, Cáceres); L.M. Tamayo (Hospital Río Carrión, Palencia); J. Blanco (Complexo Hospitalario Xeral-Calde, Lugo); P. Galdós (Hospital General de Móstoles, Madrid); F. Barredo (Hospital de Torrecárdenas, Almería); A. Rodríguez (Hospital Santa María del Rosell, Cartagena); J. Castaño (Hospital Virgen de las Nieves, Granada); A. Bonet (Hospital Josep Trueta, Girona); M. Cerdá (Hospital de la Creu Roja, L’Hospitalet de Llobregat, Barcelona); A. Torres (UVIR, Hospital Clínic i Provincial, Barcelona); F. Pérez (Fundación Jiménez Díaz, Madrid); J.M. Flores (UCI Traumatología, Hospital Virgen del Rocío, Sevilla); R. Diego (Hospital General Universitario, Valencia); C. Fernández (Complejo Hospitalario Insalud, León); A. Mas (Centre Hospitalari i Cardiologic, Manresa, Barcelona); F. Ruiz (Hospital Ciudad de Jaén, Jaén); C. León, (Hospital Nuestra Señora de Valme, Sevilla); M. Casanovas (Hospital de Igualada, Igualada, Barcelona); E.A. Sanz (Hospital Santa Ana, Motril, Granada); J.A. Artola (Hospital Naval de San Carlos, Cádiz); M.P. Luque (UCI de Traumatología, Hospital Clínico Universitario, Zaragoza); C. Palazón (Hospital General Universitario, Murcia); C. Sotillo (Hospital Gregorio Marañón, Madrid); A. Bisbal (Policlínica Miramar, Palma de Mallorca); M.J. Huertos (Hospital de Puerto Real, Cádiz); F. Esteban (Hospital Sant Joan de Reus, Reus, Tarragona); P. Ugarte (Hospital Marqués de Valdecilla, Santander); R. Giral (Hospital General Yagüe, Burgos); V. González (Hospital Miguel Servet, Zaragoza); M.J. Serralta (Hospital San Juan, Alicante); A. Cercas (Hospital de Jerez, Cádiz); A. Nebra (Hospital Clínico Universitario, Zaragoza); C. Castillo (Hospital Txagorritxu, Vitoria-Gasteiz); A. Cercas (Hospital de Jerez, Cádiz); A. Nebra (Hospital Clínico Universitario, Zaragoza); C. Castillo (Hospital Txagorritxu, Vitoria), A. Tejada (UCI Traumatología, Hospital Miguel Servet, Zaragoza); and J.I. Gómez (REA, Hospital Río Ortega, Valladolid), Spain.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

Analysis and interpretation of data: Cristóbal León, Francisco Álvarez-Lerma, Sergio Ruiz-Santana, Pedro Saavedra.

Drafting of the article

Cristóbal León, Francisco Álvarez-Lerma, María Ángeles León, Sergio Ruiz-Santana, Pedro Saavedra.

Critical revision of the article for important intellectual content

Cristóbal León, Francisco Álvarez-Lerma, Sergio Ruiz-Santana, Pedro Saavedra, Mercedes Palomar.

Provision of study materials or patients

Cristóbal León, Francisco Álvarez-Lerma, María Ángeles León, Joan Nolla, Ricard Jordà, Merceces Palomar.

Statistical expertise

Sergio Ruiz-Santana, Pedro Saavedra.

Obtaining of funding

Cristóbal León, Mercedes Palomar.

Administrative, technical or logistic support

Cristóbal Léon, María Ángeles León, Joan Nolla, Ricard Jordà, Mercedes Palomar.

Collection and assembly of data

Cristóbal León, Francisco Álvarez-Lerma, Sergio Ruiz-Santana, Pedro Saavedra, Mercedes Palomar.

Financial disclosure

This study was supported by Gilead Sciences, Madrid, Spain. The sponsor had no role in the design and execution of the study, analysis and interpretation of data, or the writing of the manuscript, and was completely uninvolved in authorship and editorial decisions.

Abstract

The purpose of this paper is to determine the incidence of fungal colonization and infection in non-neutropenic critically ill patients and to identify factors favoring infection by Candida spp. A total of 1,655 consecutive patients (>18 years of age) admitted for ≥7 days to 73 medical-surgical Spanish intensive care units (ICUs) participated in an observational prospective cohort study. Surveillance samples were obtained once a week. One or more fungi were isolated in different samples in 59.2% of patients, 94.2% of which were Candida spp. There were 864 (52.2%) patients with Candida spp. colonization and 92 (5.5%) with proven Candida infection. In the logistic regression analysis risk factors independently associated with Candida spp. infection were sepsis (odds ratio [OR] = 8.29, 95% confidence interval [CI] 5.07–13.6), multifocal colonization (OR = 3.49, 95% CI 1.74–7.00), surgery (OR = 2.04, 95% CI 1.27–3.30), and the use of total parenteral nutrition (OR = 4.37, 95% CI 2.16–8.33). Patients with Candida spp. infection showed significantly higher in-hospital and intra-ICU mortality rates than those colonized or non-colonized non-infected (P < 0.001). Fungal colonization, mainly due to Candida spp., was documented in nearly 60% of non-neutropenic critically ill patients admitted to the ICU for more than 7 days. Proven candidal infection was diagnosed in 5.5% of cases. Risk factors independently associated with Candida spp. infection were sepsis, multifocal colonization, surgery, and the use of total parenteral nutrition.

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