 |
|
Temporal Assessment of Candida Risk Factors in the Surgical Intensive Care Unit
Peggy S. McKinnon, PharmD;
Debra A. Goff, PharmD;
Jack W. Kern, PharmD;
John W. Devlin, PharmD;
Jeffrey F. Barletta, PharmD;
Sondra J. Sierawski, BSc;
Anne C. Mosenthal, MD;
Prasanna Gore, PhD;
Ambarish J. Ambegaonkar, PhD;
Teresa J. Lubowski, PharmD
Arch Surg. 2001;136:1401-1408.
Hypothesis Risk factors for Candida infection in surgical intensive care units (SICUs) change over time. Risk factor progression may influence Candida colonization and infection.
Design Multicenter cohort survey.
Setting Three urban teaching institutions.
Patients A total of 301 consecutively admitted patients in SICUs for 5 or more days.
Main Outcome Measures Assessment of patients on SICU days 1, 3, 4, 6, and 8 and SICU discharge for risk factors, Candida colonization, and antifungal use. Candida colonization status was categorized as noncolonized (NC), locally colonized (LC) if 1 site was involved, and disseminated infection (DI) if 2 or more sites or candidemia were involved.
Results The most frequent risk factors in the 301 patients enrolled were presence of peripheral and central intravenous catheters, bladder catheters, mechanical ventilation, and lack of enteral or intravenous nutrition. Early risk factors included total parenteral nutrition or central catheter at SICU day 1 and previous SICU admissions or surgical procedures. Peak number of risk factors (mean ± SD) were as follows: 7.2 ± 2.6 in NC (n = 229), 9.2 ± 2.3 in LC (n = 45), and 9.2 ± 2.6 in DI (n = 27). These numbers were reached at day 8 in the NC and LC groups and day 4 in the DI group. The LC and DI groups had more risk factors on each SICU day than the NC group and longer median SICU length of stay (28 days in the DI group vs 11 and 19 days in the NC and LC groups, respectively). Antifungal therapy, while used most frequently in the DI group, was initiated later for this group than in NC and LC groups.
Conclusions Risk factors for Candida infection in SICU patients change over time. Patients with DI demonstrate a greater number of and more rapid increase in risk factors than patients in the LC and NC groups. Presence of early risk factors at the time of SICU admission, a high incidence of risk factors, or a rapid increase in risk factors should prompt clinicians to obtain surveillance fungal cultures and consider empirical antifungal therapy.
From the Detroit Receiving Hospital, Detroit, Mich (Drs McKinnon, Devlin, and Barletta); The Ohio State University Medical Center, Columbus (Dr Goff and Ms Sierawski); Los Angeles County University of Southern California Medical Center, Los Angeles (Dr Kern); Department of Surgery, New Jersey Medical School, Newark (Dr Mosenthal); Gore and Company, Boston, Mass (Dr Gore); and Pfizer Inc, New York, NY (Drs Ambegaonkar and Lubowski). Drs Ambegaonkar and Lubowski are employed by Pfizer Inc, and Drs McKinnon and Gore are consultants with Pfizer Inc.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED ARTICLE
Temporal Assessment of Candida Risk Factors in the Surgical Intensive Care Unit—Invited Critique
Timothy G. Buchman
Arch Surg. 2001;136(12):1409.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
SSD1 Is Integral to Host Defense Peptide Resistance in Candida albicans
Gank et al.
Eukaryot Cell 2008;7:1318-1327.
ABSTRACT
| FULL TEXT
Mannose-Binding Lectin Deficiency Facilitates Abdominal Candida Infections in Patients with Secondary Peritonitis
van Till et al.
CVI 2008;15:65-70.
ABSTRACT
| FULL TEXT
Epidemiology, Risk Factors, and Outcomes of Candida albicans Versus Non-albicans Candidemia in Nonneutropenic Patients
Davis et al.
The Annals of Pharmacotherapy 2007;41:568-573.
ABSTRACT
| FULL TEXT
Risk Factors for Progression to Invasive Fungal Infection in Preterm Neonates With Fungal Colonization
Manzoni et al.
Pediatrics 2006;118:2359-2364.
ABSTRACT
| FULL TEXT
Antifungal agents for preventing fungal infections in non-neutropenic critically ill and surgical patients: systematic review and meta-analysis of randomized clinical trials
Playford et al.
J Antimicrob Chemother 2006;57:628-638.
ABSTRACT
| FULL TEXT
Parenteral Nutrition as a Risk Factor for Central Venous Catheter-Related Infection
Beghetto et al.
JPEN J Parenter Enteral Nutr 2005;29:367-373.
ABSTRACT
| FULL TEXT
Determinants of Candidemia and Candidemia-Related Death in Cardiothoracic ICU Patients
Michalopoulos et al.
Chest 2003;124:2244-2255.
ABSTRACT
| FULL TEXT
Disseminated Infection?
Hospenthal and McKinnon
Arch Surg 2002;137:868-869.
FULL TEXT
|
