Title: Major Risk Factors Associated with the Development of Candidemia in Intensive Care Units at University Hospital in Mobile, AL
Authors: Kennadi Johnson, Ashley Hawthorne, Callie Seales
Background: Data on candidemia in the United States are limited. The Centers for Disease Control and Prevention (CDC) reports that approximately 25,000 cases of candidemia occur annually with a mortality rate of 25%. Due to its opportunistic nature, candidemia is primarily seen in critically ill and immunocompromised patients. Common risk factors include immunosuppression, current Candida colonization, central venous catheter placement, recent abdominal surgery, and broad-spectrum antibiotic use, to name a few. The “Candida score” was developed in 2009 and may be utilized as a predictor of invasive Candida infection; however, it has numerous limitations. The Infectious Diseases Society of America (IDSA) 2016 Clinical Practice Guideline for Management of Candidiasis recommends initiating empiric antifungal therapy in select critically ill, non-neutropenic patients.
Methods: In this retrospective, single-site study, patients were identified via a report in the medical record to capture all patients ≥ 18 years of age in the Intensive Care Units (ICU) with Candida in ≥ 1 blood culture(s). Patients not admitted to the ICU or with neutropenia were excluded. The following data was collected: age, gender, race, date and ward of admission, length of stay, collection date of first positive Candida blood culture, vital signs and labs at ICU admission and within 72-hours of positive Candida blood culture, past medical history, time of intubation and extubation, in-hospital mortality, and empiric antifungal therapy. Pre-disposing factors including pacemaker or defibrillator placement, any mode of dialysis, central venous catheter (CVC), foley catheter, total parental nutrition (TPN) use, home medications, history of intravenous (IV) drug use, presence of multifocal Candida colonization, and recent abdominal surgery were also collected. The primary objective of this study is to identify risk factors associated with the development of candidemia in ICU at our institution. The secondary objectives are to evaluate the performance of the “Candida score”, in-hospital mortality, incidence of candidemia by ICU location, and frequency of empiric antifungal therapy. Descriptive statistics were utilized to describe the results, and the “Candida score” was calculated for each patient.
Results: Between October 1, 2018, and July 1, 2024, thirty-five patients met the inclusion criteria. The pre-disposing factors occurring in ≥ 50% of the study population were CVC (n=32, 19%), foley catheter (n=30, 86%), mechanical ventilation (n=29, 83%), and severe sepsis (n=20, 57%). Candida albicans was the most common species isolated (n=15, 43%). The percentages of patients admitted to the medical intensive care unit (MICU), surgical-trauma intensive care unit (STICU), and neuroscience intensive care unit (NSICU) were 49% (n=17), 46% (n=16), and 6% (n=2), respectively. In-hospital mortality occurred 63% (n=22) of the sample. The “Candida score” was only positive for 40% (n=14) of the sample, and 46% (n=16) of patients received empiric antifungal treatment.
Conclusion: In this analysis, CVCs, foley catheters, severe sepsis, and mechanical ventilation were the most common characteristics amongst patients who developed candidemia. Lastly, the “Candida score” failed to accurately predict the likelihood of developing in candidemia in non-neutropenic, critically ill patients at University Hospital in Mobile, AL.
