Risk factors, incidence and outcome of candidemia in a Turkish intensive care unit: a five-year retrospective cohort study

Background: Invasive fungal infections are important life threatening infections seen in immunocompromised and critically ill patients. Candida species are the most common fungal pathogens among these patients; and the most commonly recognized clinical entity of fungal infections is candidemia. The aim of this study was to investigate the incidence, risk factors and 30-day mortality associated with candidemia in the intensive care unit (ICU). Methodology: A retrospective cohort study in a tertiary care hospital ICU was undertaken from January 2004 to December 2008. Demographic and clinical data were collected from medical and microbiology laboratory records retrospectively. Results: In five years period, 66 candidemia cases were identified among 1076 cases. Overall incidence of candidemia was 12.3 per 1000 admissions and 23.1/10000 patient days. Candida albicans was the most common species (53.1%) isolated from blood specimens followed by Candida parapsilosis (21.1%). The frequencies of tracheotomy, femoral artery catheterisation, red blood cell transfusions, parenteral nutrition, abdominal surgery, and previous use of antibiotics were significantly high in candidemia group. In multivariate logistic regression model, parenteral nutrition and use of broad spectrum antibiotic combinations were found to be associated with candidemia. Crude mortality rate at 30th day was 43.9% and mortality rate of candidemia associated with C. albicans was significantly higher than with non-albicans Candida strains. Conclusion: Candida albicans was the most common isolate in candidemia patients and was associated with high mortality rates. Use of invasive procedures and broad spectrum antibiotics poses significant risks in development of candidemia.