Candidemia after cardiac surgery in the intensive care unit: an observational study

Interact Cardiovasc Thorac Surg. 2011 Mar;12(3):374-8. doi: 10.1510/icvts.2010.257931. Epub 2010 Dec 22.

Abstract

Candidemia is a well-recognized complication of hospital stay, especially in critically ill patients. There is not a general consensus that predictors for candidemia in cardiosurgical intensive care unit (cICU) are different from a general ICU and it has been reported that cardiopulmonary bypass time is a specific risk factor in the cICU. We performed a prospective study to evaluate the main predictors for candidemia in patients admitted to the cICU. Included patients were adults admitted between July 2005 and December 2007 with an ICU-length of stay (ICU-LOS) ≥48 hours after cardiac surgery. Exclusion criteria were solid organ or bone marrow transplants, previous diagnosis of candidemia or other invasive infections and ICU stay before surgery. A multiple regression analysis was performed to identify the risk factors. Among 1955 patients admitted to the cICU, 345 were enrolled. Only 26 patients (1.3%) had candidemia after an ICU-LOS of 20 days (inter-quartile range, IQR 8-49 days). Total parenteral nutrition [odds ratio (OR)=9.56; confidence interval (CI)=1.741-52.534], severe sepsis (OR=4.20; CI=1.292-13.667), simplified acute physiology score II (OR=1.16; CI=1.052-1.278) and ICU-LOS >20 days (OR=6.38; CI=1.971-20.660) were independent predictors of candidemia. Patients undergoing cardiac surgery developed candidemia late after cICU admission and the independent predictors were similar to the general ICU.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Candidemia / microbiology*
  • Candidemia / mortality
  • Cardiac Surgical Procedures / adverse effects*
  • Cardiac Surgical Procedures / mortality
  • Chi-Square Distribution
  • Cross Infection / microbiology*
  • Cross Infection / mortality
  • Female
  • Humans
  • Intensive Care Units*
  • Italy
  • Kaplan-Meier Estimate
  • Length of Stay
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors