Outcome and potentially modifiable risk factors for candidemia in critically ill burns patients: A matched cohort study.
antifungals
burns
candidemia
critically ill
outcome
risk factors
Journal
Mycoses
ISSN: 1439-0507
Titre abrégé: Mycoses
Pays: Germany
ID NLM: 8805008
Informations de publication
Date de publication:
Mar 2019
Mar 2019
Historique:
received:
06
09
2018
revised:
26
10
2018
accepted:
20
11
2018
pubmed:
28
11
2018
medline:
19
3
2019
entrez:
28
11
2018
Statut:
ppublish
Résumé
Patients with extensive burns are at risk of developing candidemia. To identify potentially modifiable risk factors and outcomes of candidemia in critically ill burns patients. Retrospective matched cohort study including adult burns patients. Patients who developed candidemia were matched with burns patients with Candida spp colonisation and sepsis or septic shock without candidemia in a ratio of 1:3 (same severity scores and colonisation index). Univariate and multiple regression analyses were performed. Of 130 severely burned patients with Candida spp colonisation and at least one episode of sepsis or septic shock, 14 were diagnosed with candidemia. In the candidemia group, patients had a median (IQR) total burns surface area (TBSA) of 57 (38-68)%, SAPSII of 43 (36-58) and ABSI of 11 (8-13). Multiple regression analysis showed that only duration of prior antibiotic therapy was independently associated with candidemia. ICU mortality was higher in the candidemia group (71% vs 35% [P = 0.02]). The log-rank test for 28-day mortality comparing patients with candidemia treated with an empirical strategy vs a curative strategy did not reach significance (P = 0.056). Burns patients having received recent antibiotherapy have a higher risk of candidemia. Antifungal strategies did not influence outcome in this series.
Sections du résumé
BACKGROUND
BACKGROUND
Patients with extensive burns are at risk of developing candidemia.
OBJECTIVES
OBJECTIVE
To identify potentially modifiable risk factors and outcomes of candidemia in critically ill burns patients.
PATIENTS AND METHODS
METHODS
Retrospective matched cohort study including adult burns patients. Patients who developed candidemia were matched with burns patients with Candida spp colonisation and sepsis or septic shock without candidemia in a ratio of 1:3 (same severity scores and colonisation index). Univariate and multiple regression analyses were performed.
RESULTS
RESULTS
Of 130 severely burned patients with Candida spp colonisation and at least one episode of sepsis or septic shock, 14 were diagnosed with candidemia. In the candidemia group, patients had a median (IQR) total burns surface area (TBSA) of 57 (38-68)%, SAPSII of 43 (36-58) and ABSI of 11 (8-13). Multiple regression analysis showed that only duration of prior antibiotic therapy was independently associated with candidemia. ICU mortality was higher in the candidemia group (71% vs 35% [P = 0.02]). The log-rank test for 28-day mortality comparing patients with candidemia treated with an empirical strategy vs a curative strategy did not reach significance (P = 0.056).
CONCLUSIONS
CONCLUSIONS
Burns patients having received recent antibiotherapy have a higher risk of candidemia. Antifungal strategies did not influence outcome in this series.
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
237-246Subventions
Organisme : la fondation des gueules cassées
Informations de copyright
© 2018 Blackwell Verlag GmbH.