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Original Article
December 2001

Temporal Assessment of Candida Risk Factors in the Surgical Intensive Care Unit

Author Affiliations

From the Detroit Receiving Hospital, Detroit, Mich (Drs McKinnon, Devlin, and Barletta); The Ohio State University Medical Center, Columbus (Dr Goff and Ms Sierawski); Los Angeles County University of Southern California Medical Center, Los Angeles (Dr Kern); Department of Surgery, New Jersey Medical School, Newark (Dr Mosenthal); Gore and Company, Boston, Mass (Dr Gore); and Pfizer Inc, New York, NY (Drs Ambegaonkar and Lubowski). Drs Ambegaonkar and Lubowski are employed by Pfizer Inc, and Drs McKinnon and Gore are consultants with Pfizer Inc.

Arch Surg. 2001;136(12):1401-1408. doi:10.1001/archsurg.136.12.1401

Hypothesis  Risk factors for Candida infection in surgical intensive care units (SICUs) change over time. Risk factor progression may influence Candida colonization and infection.

Design  Multicenter cohort survey.

Setting  Three urban teaching institutions.

Patients  A total of 301 consecutively admitted patients in SICUs for 5 or more days.

Main Outcome Measures  Assessment of patients on SICU days 1, 3, 4, 6, and 8 and SICU discharge for risk factors, Candida colonization, and antifungal use. Candida colonization status was categorized as noncolonized (NC), locally colonized (LC) if 1 site was involved, and disseminated infection (DI) if 2 or more sites or candidemia were involved.

Results  The most frequent risk factors in the 301 patients enrolled were presence of peripheral and central intravenous catheters, bladder catheters, mechanical ventilation, and lack of enteral or intravenous nutrition. Early risk factors included total parenteral nutrition or central catheter at SICU day 1 and previous SICU admissions or surgical procedures. Peak number of risk factors (mean ± SD) were as follows: 7.2 ± 2.6 in NC (n = 229), 9.2 ± 2.3 in LC (n = 45), and 9.2 ± 2.6 in DI (n = 27). These numbers were reached at day 8 in the NC and LC groups and day 4 in the DI group. The LC and DI groups had more risk factors on each SICU day than the NC group and longer median SICU length of stay (28 days in the DI group vs 11 and 19 days in the NC and LC groups, respectively). Antifungal therapy, while used most frequently in the DI group, was initiated later for this group than in NC and LC groups.

Conclusions  Risk factors for Candida infection in SICU patients change over time. Patients with DI demonstrate a greater number of and more rapid increase in risk factors than patients in the LC and NC groups. Presence of early risk factors at the time of SICU admission, a high incidence of risk factors, or a rapid increase in risk factors should prompt clinicians to obtain surveillance fungal cultures and consider empirical antifungal therapy.