J Korean Med Sci.  2010 May;25(5):671-676. 10.3346/jkms.2010.25.5.671.

Clinical Characteristics and Risk Factors for Nosocomial Candidemia in Medical Intensive Care Units: Experience in a Single Hospital in Korea for 6.6 Years

• Han SS
• Yim JJ
• Yoo CG
• Kim YW
• Han SK
• Shim YS
• Lee SM

• KMID: 1713948
• DOI: http://doi.org/10.3346/jkms.2010.25.5.671

Abstract

The aim of this study was to determine candidemia incidence among patients in a medical intensive-care unit (MICU) and the associated mortality rate and to identify risk factors associated with candidemia. We retrospectively performed a 1:3 matched case-control study of MICU patients with candidemia. Controls were matched for sex, age, and Acute Physiology and Chronic Health Evaluation (APACHE) II score. Candidemia incidence was 9.1 per 1,000 admissions. The most common pathogen was Candida albicans. Crude mortality was 96% among candidemia patients and 52% among controls (P<0.001). Mortality differed significantly between the groups according to Kaplan-Meier survival analysis (P=0.024). Multivariate analysis identified the following independent risk factors for candidemia: central venous catheterization (odds ratio [OR] = 3.2, 95% confidence interval [CI]=1.2-9.0), previous steroid therapy (OR=4.7, 95% CI=1.8-12.1), blood transfusion during the same admission period (OR=6.3, 95% CI=2.4-16.7), and hepatic failure upon MICU admission (OR=6.9, 95% CI=1.7-28.4). In conclusion, we identify an additional independent risk factor for candidemia, the presence of hepatic failure on MICU admission. Therefore, increased awareness of risk factors, including hepatic failure, is necessary for the management of candidemia.

Keyword

Fungemia; Candidiasis; Intensive-Care Units; Mortality; Risk Factors

MeSH Terms

Candidiasis/*diagnosis/*epidemiology
Cross Infection/*diagnosis/*epidemiology
Female
Hospitalization/*statistics & numerical data
Humans
Incidence
Intensive Care Units/*statistics & numerical data
Korea/epidemiology
Longitudinal Studies
Male
Middle Aged
Pilot Projects
Risk Assessment/methods
Risk Factors

Figure

• 

  Fig. 1 Kaplan-Meier survival curves for candidemia patients and controls in an MICU. The solid line indicates the cumulative survival of 49 patients with candidemia and the dashed line indicates the cumulative survival of 147 control patients (P=0.024).

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