Behavior of Candidemia in an Intensive Care Unit
Keywords:
candidemia, critical patient, antifungal drugs, mortalityAbstract
Introduction: invasive candidiasis has increased and, although C albicans is the most frequent one, non-albicans species of Candida resistant to antifungal therapy, are emerging.
Objective: to characterize critically ill patients admitted to the Intensive Care Unit 8B of the "Hermanos Ameijeiras" Clinical and Surgical Hospital with a confirmed diagnosis of fungemia as well as to identify microbiological resistance patterns and the use of antifungal therapy.
Methods: a longitudinal, descriptive and prospective study was conducted in 52 patients who were admitted to this hospital from January 2006 to December 2009. An analysis of mortality was done and the SOFA and the Sevilla Score were applied. Pearson Chi-Square (X2) test was used for the association between the variables. An statistical significance of p 0,05 was considered.
Results: of the 52 patients studied, 29 were women (55,8 %) and 23 were men (44,2 %). The mean age was 56,8 (± 17,013) years and 26 of them stayed in hosptital > 15 d; 34/ 65,4 % reported scores > 12 in the Sevilla Score. 35 patients died (67,3 %); the majority (36/69,2 %) presented non- albicans Candida ; 41 required mechanical ventilation; 9 patients survived (22 %) and 32 patients died (78 %) (p=0.003). Also, the difference (alive/dead) was significant for parenteral nutrition (p=0,003). There was a greater mortality in patients with non-albicans Candida (p=0,016). Although antifungal resistance was not elevated, it was higher in the non-albicans Candida species. 43 patients presented multiple organ dysfunction, 31(72,1 %) received specific treatment and 12 (27,9 %) received empirical treatment. Among the patients without multiple organ dysfunction, 7 (77,8 %) received empirical treatment, and 2 (22,2 %) received specific treatment (p= 0,008). The majority of the patients who received empirical treatment survived; among the dead patients, the majority received specific treatment (p=0,03).
Conclusions: candidemia is a late infection of high mortality. Patients with isolations of non-albicans Candida predominated, who were associated to greater mortality and high antifungal resistance. The patients who received specific treatment had a worse evolution.
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