Predisposing factors for candidemia in patients with major burns

•We examined the occurrence of candidemia among patients with severe burns.•In the present cohort we found a high candidemia incidence rate of 11%.•An AIC based model selection procedure for logistic regression models was utilized.•We identified gastrointestinal complications as independent risk factor for Candidemia.•A prophylactic antifungal therapy in burn patients with gastrointestinal complications might be warranted.

BackgroundDespite advances in surgery and critical care, candidemia remains a significant cause of morbidity and mortality in patients with extensive burns.MethodsA retrospective single-center cohort study was performed on 174 patients admitted to the Burn Intensive Care Unit of the General Hospital of Vienna (2007–2013). An AIC based model selection procedure for logistic regression models was utilized to identify factors associated with the presence of candidemia.ResultsTwenty (11%) patients developed candidemia on median day 16 after ICU admission associated with an increased overall mortality (30% versus 10%). Statistical analysis identified the following factors associated with proven candidemia: younger age (years) odds ratio (OR):0.96, 95% confidence interval (95% CI):0.92–1.0, female gender (reference male) OR:5.03, 95% CI:1.25–24.9, gastrointestinal (GI) complications requiring surgery (reference no GI complication) OR:20.37, 95% CI:4.25–125.8, non-gastrointestinal thromboembolic complications (reference no thromboembolic complication) OR:17.3, 95% CI:2.57–170.4 and inhalation trauma (reference no inhalation trauma) OR:7.96, 95% CI:1.4–48.4.ConclusionsAbove-mentioned patient groups are at considerably high risk for candidemia and might benefit from a prophylactic antifungal therapy. Younger age as associated risk factor is likely to be the result of the fact that older patients with a great extent of burn body surface have a lower chance of survival compared to younger patients with a comparable TBSA.