• Olivier Leroy, Jean-Pierre Gangneux, Philippe Montravers, Jean-Paul Mira, François Gouin, Jean-Pierre Sollet, Jean Carlet, Jacques Reynes, Michel Rosenheim, Bernard Regnier, Olivier Lortholary, and AmarCand Study Group.
• Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Gustave Dron, Tourcoing, France. oleroy@ch-tourcoing.fr
• Crit. Care Med. 2009 May 1;37(5):1612-8.

ObjectiveTo describe the evolving epidemiology, management, and risk factors for death of invasive Candida infections in intensive care units (ICUs).DesignProspective, observational, national, multicenter study.SettingOne hundred eighty ICUs in France.PatientsBetween October 2005 and May 2006, 300 adult patients with proven invasive Candida infection who received systemic antifungal therapy were included.InterventionsNone.Measurements And Main ResultsOne hundred seven patients (39.5%) with isolated candidemia, 87 (32.1%) with invasive candidiasis without documented candidemia, and 77 (28.4%) with invasive candidiasis and candidemia were eligible. In 37% of the cases, candidemia occurred within the first 5 days after ICU admission. C. albicans accounted for 57.0% of the isolates, followed by C. glabrata (16.7%), C. parapsilosis (7.5%), C. krusei (5.2%), and C. tropicalis (4.9%). In 17.1% of the isolates, the causative Candida was less susceptible or resistant to fluconazole. Fluconazole was the empirical treatment most commonly introduced (65.7%), followed by caspofungin (18.1%), voriconazole (5.5%), and amphotericin B (3.7%). After identification of the causative species and susceptibility testing results, treatment was modified in 86 patients (31.7%). The case fatality ratio in ICU was 45.9% and did not differ significantly according to the type of episode. Multivariate analysis showed that factors independently associated with death in ICU were type 1 diabetes mellitus (odds ratio [OR] 4.51; 95% confidence interval [CI] 1.72-11.79; p = 0.002), immunosuppression (OR 2.63; 95% CI 1.35-5.11; p = 0.0045), mechanical ventilation (OR 2.54; 95% CI 1.33-4.82; p = 0.0045), and body temperature >38.2 degrees C (reference, 36.5-38.2 degrees C; OR 0.36; 95% CI 0.17-0.77; p = 0.008).ConclusionsMore than two thirds of patients with invasive candidiasis in ICU present with candidemia. Non-albicans Candida species reach almost half of the Candida isolates. Reduced susceptibility to fluconazole is observed in 17.1% of Candida isolates. Mortality of invasive candidiasis in ICU remains high.

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