Background: The incidence of invasive fungal disease (IFD) is increasing worldwide in the past two to three decades. Critically ill patients in Intensive Care Units are more vulnerable to fungal infection. Early detection and treatment are important to decrease morbidity and mortality in critically ill patients.
Objective: Our study aimed to assess factors associated with early IFD in critically ill patients.
Materials and Methods: This prospective cohort study was conducted in critically ill patients, from March to September 2015. Total number of patients (74) in this study was drawn based on one of the risk factors (human immunodeficiency virus). Specimens were collected on day 5–7 of hospitalization. Multivariate analysis with logistic regression was performed for factors, with P< 0.25 in bivariate analysis.
Results: Two hundred and six patients were enrolled in this study. Seventy-four patients were with IFD, majority were males (52.7%), mean age was 58 years (range 18–79), mean Leon's score was 3 (score range 2–5), majority group was nonsurgical/nontrauma (72.9%), and mean fungal isolation was positive on day 5. Candida sp. (92.2%) is the most frquently isolated fungal infection. Urine culture yielded the highest number of fungal isolates (70.1%). Mortality rate in this study was 50%. In multivariate analysis, diabetes mellitus (DM) (P = 0.018, odds ratio 2.078, 95% confidence interval 1.135–3.803) was found as an independent factor associated with early IFD critically ill patients.
Conclusion: DM is a significant factor for the incidence of early IFD in critically ill patients.
Yang SP, Chen YY, Hsu HS, Wang FD, Chen LY, Fung CP. A risk factor analysis of healthcare-associated fungal infections in an intensive care unit: A retrospective cohort study. BMC Infect Dis 2013;13:10.
Muskett H, Shahin J, Eyres G, Harvey S, Rowan K, Harrison D. Risk factors for invasive fungal disease in critically ill adult patients: A systematic review. Crit Care 2011;15:R287.
Eggimann P, Bille J, Marchetti O. Diagnosis of invasive candidiasis in the ICU. Ann Intensive Care 2011;1:37.
León C, Ruiz-Santana S, Saavedra P, Almirante B, Nolla-Salas J, Alvarez-Lerma F, et al. A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med 2006;34:730-7.
Singh T, Kashyap AK, Ahluwalia G, Chinna D, Sidhu SS. Epidemiology of fungal infections in critical care setting of a tertiary care teaching hospital in North India: A prospective surveillance study. J Clin Sci Res 2014;3:14-25.
Paswan AK, Raju DC, Singh DK, Dubey RK, Mishra PK. An observational study of the risk factors and incidence of invasive fungal infections in ICU patients. Anaesth Pain Intensive Care 2013;17:136-40.
Leleu G, Aegerter P, Guidet B; Collège des Utilisateurs de Base de Données en Réanimation. Systemic candidiasis in intensive care units: A multicenter, matched-cohort study. J Crit Care 2002;17:168-75.
Gudlaugsson O, Gillespie S, Lee K, Vande Berg J, Hu J, Messer S, et al. Attributable mortality of nosocomial candidemia, revisited. Clin Infect Dis 2003;37:1172-7.
Zaoutis TE, Prasad PA, Localio AR, Coffin SE, Bell LM, Walsh TJ, et al. Risk factors and predictors for candidemia in pediatric intensive care unit patients: Implications for prevention. Clin Infect Dis 2010;51:e38-45.
Resultanti. Risk factor for candidemia in non-neutropenia septic patients [master's thesis]. Jakarta, Indonesia: Universitas Indonesia; 2015.
Leroy G, Lambiotte F, Thévenin D, Lemaire C, Parmentier E, Devos P, et al. Evaluation of “Candida score” in critically ill patients: A prospective, multicenter, observational, cohort study. Ann Intensive Care 2011;1:50.
Deorukhkar SC, Saini S, Mathew S. Non-albicans Candida infection: An emerging threat. Interdiscip Perspect Infect Dis 2014;2014:615958.
Mane A, Pawale C, Gaikwad S, Bembalkar S, Risbud A. Adherence to buccal epithelial cells, enzymatic and hemolytic activities of Candida isolates from HIV-infected individuals. Med Mycol 2011;49:548-51.
Donowitz GR, Maki DG, Crnich CJ, Pappas PG, Rolston KV. Infections in the neutropenic patient – New views of an old problem. Hematology 2001;1:113-39
Casqueiro J, Casqueiro J, Alves C. Infections in patients with diabetes mellitus: A review of pathogenesis. Indian J Endocrinol Metab 2012;16 Suppl 1:S27-36.
Chow JK, Golan Y, Ruthazer R, Karchmer AW, Carmeli Y, Lichtenberg DA, et al. Risk factors for albicans and non-albicans candidemia in the intensive care unit. Crit Care Med 2008;36:1993-8.
Fraser VJ, Jones M, Dunkel J, Storfer S, Medoff G, Dunagan WC. Candidemia in a tertiary care hospital: Epidemiology, risk factors, and predictors of mortality. Clin Infect Dis 1992;15:414-21.
Blumberg HM, Jarvis WR, Soucie JM, Edwards JE, Patterson JE, Pfaller MA, et al. Risk factors for candidal bloodstream infections in surgical intensive care unit patients: The NEMIS prospective multicenter study. The National Epidemiology of Mycosis Survey. Clin Infect Dis 2001;33:177-86.
O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2011;39 4 Suppl 1:S1-34.
Pittet D, Monod M, Suter PM, Frenk E, Auckenthaler R. Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg 1994;220:751-8.
Wey SB, Mori M, Pfaller MA, Woolson RF, Wenzel RP. Risk factors for hospital-acquired candidemia. A matched case-control study. Arch Intern Med 1989;149:2349-53.
Ferrara JJ, MacDougall C, Gallagher JC. Empiric antifungal therapy in patients with febrile neutropenia. Pharmacotherapy 2011;31:369-85.
Angele MK, Faist E. Clinical review: Immunodepression in the surgical patient and increased susceptibility to infection. Crit Care 2002;6:298-305.
Swierzewski JJ. Update 99: Fungal Infection Risk Factors. Lyme Disease Prevention Tips; 13 August, 2015. Available from: http://www.healthcommunities.com. [Last accessed on 2015 Oct 29].
Alp E, Voss A. Ventilator associated pneumonia and infection control. Ann Clin Microbiol Antimicrob 2006;5:7.