An observational study of the risk factors and incidence of invasive fungal infections in ICU patientsAn observational study of the risk factors and incidence of invasive fungal infections in ICU patients

Abstract

Background: The fungal infections have become a persistent health problem, still always remain under reported.
A change in species distribution has been observed now a days with the emergence of many non-albicans candida
species.
Objective: Our study aimed at evaluating the incidence of invasive Candidiasis (Candida albicans and non-albicans)
and to assess the risk factors and predictors of mortality in seriously ill patients.
Methodology: This prospective, observational study was conducted at Division of Intensive Care Unit, Institute
of Medical Science, BHU, Varanasi (India), during the period of 2009 to 2011. Patients with >8 out of 16 risk
factors, e.g. prolonged antibiotic use, IV cannulation, steroid use etc, Candida scores (CS) > 2, Age >12 years
and ICU stay >2 days were included in the study. Those with Candida scores > 3 were prophylactically given
fluconazole.
A case report performa was completed for each patient, including demographic characteristics, dates of hospital
and ICU admission and of discharge, vital sign status at discharge, previous treatment with antibiotics or
immunosuppressive agents, presence of risk factors. Patients were followed till discharge from the ICU or death.
Results: Candida was isolated from blood in 53/206 patients. The P-value calculated in five risk groups, e.g.
diabetics, patients receiving TPN, neutropenic patients, HIV and malignancy was significant (P<0.05). For all
other risk factors P-value was >0.05. Over half of the Candida isolates recovered from blood were non-albicans
species. The overall mortality in candidaemia patients was 37/53 (69.81%). Mortality was low with Candida
tropicalis (57.7%) but number of patient was high among candida species.
Conclusion: Multiple risk factors were found to be associated with invasive fungal infection in critically ill
patients. In the ICU population studied, candidemia was due to non-albicans spp. The importance of Candida
scores on predicting mortality was also observed