• Zeyad Aljeboori, Alexandra Gorelik, Emily Jenkins, Thomas McFarlane, and Jai Darvall.
• Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Vic, Australia. Z.Aljeboori@alfred.org.au.
• Crit Care Resusc. 2018 Dec 1; 20 (4): 313-319.

ObjectivesThere is an increasing incidence of invasive candidal infections in critically ill patients worldwide, which has prompted development of various risk prediction rules, both clinical and microbiological. To date, however, there is a lack of research into how cumulative risk factors over time affect transition to candidaemia. The aim of this study was to investigate the association of risk factor accumulation over time with candidaemia in a cohort of critically ill, non-neutropenic adult patients.Design, Setting And ParticipantsA single centre, retrospective, matched case-control study in a tertiary referral intensive care unit (ICU). Data were retrieved and analysed from 108 patients (54 cases and 54 controls) admitted between 1 January 2008 and 1 August 2016.Main Outcome MeasuresPrimary outcome was the association between time-dependent risk factors and candidaemia. Secondary outcomes were ICU and inhospital mortality.ResultsBaseline demographic and clinical factors were similar across both groups. Time dependent univariate factors associated with candidaemia were days of mechanical ventilation, systemic antibiotic use, renal replacement therapy, central venous access, total parenteral nutrition (TPN), systemic inflammatory response syndrome, Candida site colonisation and number of surgeries. Factors persisting on multivariate analysis were days of TPN use (odds ratio [OR], 1.8; 95% CI, 1.02-3.22; P = 0.041) and total Candida site colonisation days (OR, 2.41; 95% CI, 1.30-4.46; P = 0.005). Mortality and length of stay (LOS) was greater in patients with candidaemia v control patients (ICU mortality, 15 [28%] v 10 [19%]; P = 0.254; hospital mortality, 26 [48%] v 16 [30%]; P = 0.048; ICU LOS median, 13 days [interquartile range (IQR), 5-29 days] v 2 days [IQR, 1-5 days]; P < 0.001; hospital LOS median, 36 days [IQR,19- 63 days] v 13 days [IQR, 6-28 days]; P < 0.001).ConclusionThis study demonstrates an association between TPN use, Candida colonisation and cumulative risk over time of developing candidaemia.

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