Prognostic factors and historical trends in the epidemiology of candidemia in critically ill patients: an analysis of five multicenter studies sequentially conducted over a 9-year period

• Autor(a) principal: Colombo, Arnaldo Lopes [UNIFESP]
• Data de Publicação: 2014
• Outros Autores: Guimarães, Thaís [UNIFESP], Sukienik, Teresa, Pasqualotto, Alessandro Comaru, Andreotti, Ricardo [UNIFESP], Queiroz-Telles, Flávio, Nouer, Simone A., Nucci, Marcio
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: http://dx.doi.org/10.1007/s00134-014-3400-y; http://repositorio.unifesp.br/handle/11600/38234
• topic: Candidemia; Mortality; Antifungal therapy; Echinocandin; Invasive candidiasis

To describe temporal trends in the epidemiology, clinical management and outcome of candidemia in intensive care unit (ICU) patients.This study was a retrospective analysis of 1,392 episodes of candidemia in 647 adult ICU patients from 22 Brazilian hospitals. the characteristics of candidemia in these ICU patients were compared in two periods (2003-2007, period 1; 2008-2012, period 2), and the predictors of 30-day mortality were assessed.The proportion of patients who developed candidemia while in the ICU increased from 44 % in period 1 to 50.9 % in period 2 (p = 0.01). Prior exposure to fluconazole before candidemia (22.3 vs. 11.6 %, p < 0.001) and fungemia due to Candida glabrata (13.1 vs. 7.8 %, p = 0.03) were more frequent in period 2, as was the proportion of patients receiving an echinocandin as primary therapy (18.0 vs. 5.9 %, p < 0.001). the 30-day mortality rate decreased from 76.4 % in period 1 to 60.8 % in period 2 (p < 0.001). Predictors of 30-day mortality by multivariate analysis were older age, period 1, treatment with corticosteroids and higher APACHE II score, while treatment with an echinocandin were associated with a higher probability of survival.We found a clear change in the epidemiology and clinical management of candidemia in ICU patients over the 9-year period of the study. the use of echinocandins as primary therapy for candidemia appears to be associated with better outcomes.