Risk Factors for the Development of Nosocomial Candidemia among Patients in Intensive Care Unit

Lee, You Hyun; Choi, Hee Jung; Lee, Mi Ae

Abstract

BACKGROUND: Nosocomial candidemia is one of the most important disease entity in hospital not only because of increasing incidence but also because of its high fatality rate. The purpose of this study is to identify risk factors predicting the development of nosocomial candidemia and to evaluate its clinical outcome of nosocomial candidemia in the intensive care unit (ICU) patients. MATERIALS & METHODS: We conducted a retrospective, matched case-control study in adult patients admitted to ICU from January 1998 through December 2002 in Ewha Womans University Mokdong hospital. Sixty cases with candidemia were retrospectively identified from the records of the Department of Clinical Microbiology. The possible risk factors for the development of nosocomial candidemia were compared between 60 patients and 120 control subjects.
RESULTS
Candida albicans was the most commonly isolated organism. In the multivariate analysis, number of concomitant bacteremia (OR=17.3), number of candida infection in other site (OR=20.6), number of antibiotics used (OR=4.2), duration of indwelling central venous catheter (OR=16.1), and insertion of arterial line for more than 8 days (OR=6.9) were identified as significant risk factors for development of candidemia. Crude mortality rate was higher in candidemia patients compared with control subjects (P=0.004).
CONCLUSION
The best predictors of development of candidemia in ICU patients were concomitant bacteremia, candida colonization in other site, combined use of antibiotics, and long-indwelling arterial and central venous catheter. For the ICU patients with high risk factors of candidemia, we could consider the intervention to prevent emergence of candidemia.