Risk factors for candidemia in non-neutropenic critical patients in Colombia

ObjectivesDue to the increase in isolation of Candida spp. in critically ill patients, and the high mortality and economic costs which this infection entails, a study was made of the risk factors associated to candidemia in critically ill patients from 7 intensive care units in Colombia.Materials and methodsA multicenter matched case–control study was conducted in 7 intensive care units of 3 university hospitals. Data on overall length of hospital stay (including both general wards and the intensive care unit) were recorded.ResultsA total of 243 subjects (81 cases and 162 controls) between January 2008 and December 2012 were included. In order of frequency, Candida albicans, Candida tropicalis and Candida parapsilosis were isolated. The main identified risk factors were: overall length of hospital stay >25 days (OR 5.33, 95%CI 2.6–10.9), use of meropenem (OR 3.75, 95%CI 1.86–7.5), abdominal surgery (OR 2.9, 95%CI 1.39–6.06) and hemodialysis (OR 3.35, 95%CI 1.5–7.7). No differences in mortality between patients with candidemia and controls were found (39.5 versus 36.5%, respectively; p = 0.66).ConclusionsIn Colombia, a long hospital stay, abdominal surgery, the use of meropenem and hemodialysis were identified as risk factors for candidemia.

ResumenObjetivosDeterminar los factores de riesgo asociados a candidemia en pacientes críticos de 7 unidades de cuidados intensivos de Colombia.Materiales y métodosEstudio de casos y controles pareado, multicéntrico, retrospectivo, en 7 unidades de cuidados intensivos de 3 hospitales universitarios. Se tomaron datos de duración de la estancia hospitalaria global (incluyendo salas generales) y en la unidad de cuidados intensivos.ResultadosSe incluyeron 243 participantes (81 casos y 162 controles) entre enero de 2008 y diciembre de 2012. Se aislaron en orden de frecuencia C. albicans, C. tropicalis y C. parapsilosis. Los principales factores de riesgo identificados fueron: tiempo de estancia hospitalaria global > 25 días (OR 5,33; IC 95% 2,6-10,9), uso de meropenem (OR 3,75; IC 95% 1,86-7,5), cirugía abdominal (OR 2,9; IC 95% 1,39-6,06) y hemodiálisis (OR 3,35; IC 95% 1,5-7,7). No se encontraron diferencias en mortalidad entre los grupos de pacientes con candidemia y el grupo control (39,5 frente a 36,5%; p = 0,66).ConclusionesSe identificaron como factores de riesgo para candidemia en Colombia la larga estancia hospitalaria, la cirugía abdominal, el uso de meropenem y la hemodiálisis.