To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida
bloodstream infections in intensive care
unit patients and compare Candida
with bacterial bloodstream infection.
A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida
, Gram-positive, Gram-negative, and combined Candida
/bacterial bloodstream infection. Outcome data were assessed at intensive care
unit and hospital discharge.
EPIC II included 1265 intensive care
units in 76 countries.
Patients in participating intensive care
units on study day.
Measurement and Main Results:
Of the 14,414 patients in EPIC II, 99 patients had Candida
bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstream infections. Candida albicans
(n = 70) was the predominant species. Primary therapy included monotherapy with fluconazole (n = 39), caspofungin (n = 16), and a polyene-based product (n = 12). Combination therapy was infrequently used (n = 10). Compared with patients with Gram-positive (n = 420) and Gram-negative (n = 264) bloodstream infections, patients with candidemia were more likely to have solid tumors (p
< .05) and appeared to have been in an intensive care
unit longer (14 days [range, 5–25 days], 8 days [range, 3–20 days], and 10 days [range, 2–23 days], respectively), but this difference was not statistically significant. Severity of illness and organ dysfunction scores were similar between groups. Patients with Candida
bloodstream infections, compared with patients with Gram-positive and Gram-negative bloodstream infections, had the greatest crude intensive care
unit mortality rates (42.6%, 25.3%, and 29.1%, respectively) and longer intensive care
unit lengths of stay (median [interquartile range]) (33 days [18–44], 20 days [9–43], and 21 days [8–46], respectively); however, these differences were not statistically significant.
Candidemia remains a significant problem in intensive care
units patients. In the EPIC II population, Candida albicans
was the most common organism and fluconazole remained the predominant antifungal agent used. Candida
bloodstream infections are associated with high intensive care
unit and hospital mortality rates and resource use.