This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (15) Citing Articles via Google Scholar Google Scholar Articles by Dimopoulos, G. Articles by Falagas, M. E. Search for Related Content PubMed PubMed Citation Articles by Dimopoulos, G. Articles by Falagas, M. E. Related Collections Critical Care Complications

---

CRITICAL CARE AND TRAUMA

Candida Albicans Versus Non-Albicans Intensive Care Unit-Acquired Bloodstream Infections: Differences in Risk Factors and Outcome

George Dimopoulos, MD, FCCP^*, Fotinie Ntziora, MD, George Rachiotis, MD^*, Apostolos Armaganidis, MD, and Matthew E. Falagas, MD, MSc, DSc^||

From the *Intensive Care Unit, Sotiria Hospital, Athens, Greece; Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece; Intensive Care Unit, Attikon University Hospital, Athens, Greece; Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts; and ||Department of Medicine, Henry Dunant Hospital, Athens, Greece.

Address correspondence and reprint requests to Matthew E. Falagas, MD, MSc, DSc, Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos St., 151 23 Marousi, Greece. Address e-mail to m.falagas{at}aibs.gr.

OBJECTIVE: In this study we sought to identify differences in risk factors and outcome of critically ill patients with Candida albicans and non-albicans candidemia.

METHODS: Nonimmunosuppressed, nonneutropenic patients with candidemia diagnosed after intensive care unit (ICU) admission were included in a prospective observational study in a medical-surgical ICU at a tertiary academic hospital in Athens, Greece.

RESULTS: During the study period (January 2001 to December 2005), 56 candidemia episodes in 1037 ICU admissions were included (5.4%). Of these patients, 36/56 (64.3%) had candidemia due to C. albicans and 20/56 (35.7%) due to non-albicans species (8/56 [14.3%] C. glabrata, 6/56 [10.7%] C. tropicalis, 3/56 [5.4%] C. parapsilosis, 1/56 [1.8%] C. lusitaniae, 1/56 [1.8%] C. krusei and 1/56 [1.8%] C. dubliniensis). Administration of glucocorticosteroids, central venous catheter placement, and preexisting candiduria were independently associated with candidemia due to C. non-albicans species (Odds ratio [OR]: 45.1, 95% confidence interval [CI]: 3.0–669.9; OR: 26.2, 95% CI: 2.1–334.8; and OR: 16.5, 95% CI: 1.6–173.9, respectively). The treatment response rate differed significantly between patients with C. albicans and patients with C. non-albicans bloodstream infections (29/36 [80.6%] vs 9/20 [45%], P = 0.006). Overall mortality was higher in patients with non-albicans species than C. albicans bloodstream infections (18/20 [90%] vs 19/36 [52.8%], P = 0.005). Multivariable logistic regression analysis revealed that candidemia due to non-albicans species was independently associated with death (OR: 6.7, 95% CI: 1.2–37.7).

CONCLUSIONS: In the subset of critically ill nonimmunosuppressed patients, candidemia caused by non-albicans species occurred more frequently in those with medical devices or receiving steroids. Candidemia due to non-albicans species was also associated with higher mortality.

This article has been cited by other articles:

				G. Dimopoulos, A. Velegraki, and M. E. Falagas A 10-Year Survey of Antifungal Susceptibility of Candidemia Isolates from Intensive Care Unit Patients in Greece Antimicrob. Agents Chemother., March 1, 2009; 53(3): 1242 - 1244. [Abstract] [Full Text] [PDF]

				D. M. Vandijck, S. I. Blot, L. Vandekerckhove, and D. P. Vogelaers Fluconazole Exposure and Selection for Candida Non-albicans Anesth. Analg., December 1, 2008; 107(6): 2091 - 2091. [Full Text] [PDF]

				G. Dimopoulos and M. E. Falagas Selection for Candida Non-albicans spp. After Fluconazole Use Anesth. Analg., December 1, 2008; 107(6): 2091 - 2092. [Full Text] [PDF]