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Table 3 Microbiological and clinical characteristics among 268 ICI patients receiving antifungal therapy in the China-SCAN study

From: Initial therapeutic strategy of invasive candidiasis for intensive care unit patients: a retrospective analysis from the China-SCAN study

Variables Empirical
N = 142
Pre-emptive
N = 53
Targeted
N = 73
P-value
Source of candidiasis, n (%)a
 Blood culture 138 (97.2) 51 (96.2) 68 (93.2) 0.366
 Proven catheter-relatedb 12 (8.5) 10 (18.9) 7 (6.8) 0.056
 Abdominal 2 (1.4) 1 (1.9) 6 (8.2) 0.026
 Intracranial 1 (0.7) 1 (1.9) 1 (1.4) 0.762
 Pulmonary - 1 (1.9) - 0.131
 Pleural 1 (0.7) - - 0.641
Pathogenic Candida species, n (%)c
C. albicans 56 (39.4) 20 (37.7) 31 (42.5) 0.854
C.tropicalis 18 (12.7) 10 (18.9) 9 (12.3) 0.490
C.glabrata 18 (12.7) 11 (20.8) 8 (11.0) 0.247
C.parapsilosis 21 (14.8) 7 (13.2) 14 (19.2) 0.605
 Uncategorized 11 (7.7) 5 (9.4) 6 (8.2) 0.930
Initial antifungal therapyd
 Categories, n (%)e
  fluconazole 61 (43.0) 16 (30.2) 24 (32.9) 0.160
  caspofungin 27 (19.0) 20 (37.7) 17 (23.3) 0.024
  voriconazole 20 (14.1) 8 (15.1) 21 (28.8) 0.025
 Susceptibility, n (%)
  susceptible 125 (88.0) 48 (90.6) 68 (93.2) 0.490
  completely resistant 9 (6.3) 3 (5.7) 3 (4.1) 0.797
  Duration, days 8.5 (10.0) 6.0 (9.8) 7.0 (12.0) 0.932
  Drug Adjustment, n (%) 67 (47.2) 35 (66.0) 30 (41.1) 0.017
 Procedures at diagnosis, n (%)
  APACHE II score 19.5 ± 8.1 20.9 ± 8.8 21.2 ± 7.4 0.517
  SOFA score 6.7 ± 3.5 8.2 ± 4.1 6.2 ± 3.7 0.010
  Vasopressor 44 (31.0) 18 (34.0) 21 (28.8) 0.824
 Catheterization, n (%)f
  central venous 90 (64.7) 37 (69.8) 58 (79.5) 0.086
  indwelling arterial 19 (13.8) 9 (17.3) 5 (7.0) 0.202
  drainage tube 37 (26.8) 21 (42.0) 21 (29.6) 0.133
  urethral 100 (70.9) 41 (77.4) 52 (72.2) 0.668
Central venous catheter removed within 48 h after first positive sample obtained, n (%) 102 (71.8) 28 (52.8) 49 (67.1) 0.043
Drainage catheter removed within 48 h after first positive sample obtained, n (%) 16 (11.3) 6 (11.3) 8 (11.0) 0.997
Immunopotentiation therapy, n (%)g 55 (38.7) 32 (60.4) 34 (46.6) 0.025
Microbiological evaluation, n (%)
 Eradication 73 (51.4) 27 (50.9) 36 (49.3) 0.958
Persistence 6 (4.2) 9 (17.0) 9 (12.3) 0.011
Clinical resolution, n (%)     0.045
 Complete remission 61 (43.3) 11 (21.2) 22 (30.1) 0.009
 Improvement 105 (74.5) 35 (67.3) 53 (72.6) 0.613
Clinical outcome
 ICU mortality, n (%)h 42 (32.1) 26 (57.8) 27 (43.5) 0.008
 Hospital mortality, n (%)h 43 (32.8) 27 (60.0) 29 (46.8) 0.004
 ICU duration, days 26.0 (30.5) 26.0 (26.0) 33.0 (44.8) 0.473
 Hospital duration, days 44.0 (50.0) 32.0 (47.0) 44.0 (62.8) 0.357
  1. Continuous variables are expressed as the means ± SD or medians (IQR). All the other data are raw numbers (%)
  2. APACHE II Acute Physiology and Chronic Health Evaluation II, SOFA sequential organ failure assessment
  3. aDiagnostic confirmation was based solely on at least one positive blood culture in 257 (95.9%) cases, on positive fluid culture from a normally sterile site (cerebral spinal fluid, ascitic fluid or pleural fluid) in 10 (3.7%) cases and on candidaemia combined with positive culture from a normally sterile site in 3 (1.1%) cases. Diagnosis was confirmed by histopathology in 1 patient (0.3%)
  4. bThe catheter-related blood stream infection was diagnosed according to a previous study (Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, Raad II, Rijnders BJ, Sherertz RJ, Warren DK: Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009, 49: 1–45)
  5. c C. albicans,C. tropicalis,C. glabrata, and C. parapsilosis were the most prevalent species isolated. But some sample was not pure infected by single fungi from these four fungal. That is to say, mixed fungal infection existed. The proportion of C. albicans,C. tropicalis,C. glabrata, and C. parapsilosis combined others fungi were 1.9% (2/107), 2.7% (1/37), 2.7% (1/37), 2.4% (1/42), respectively. Uncategorized Candida species included the fungal isolates with proven yeast forms that were most suggestive of Candida spp. without further characterization (n = 22)
  6. dFirst-line treatment comprised drug combination in 4/268 (1.5%) patients, 1 (0.9%) in empirical therapy group, 1 (1.2%) in pre-emptive therapy group, and 2 (2.6%) in targeted therapy group
  7. eFluconazole (101/268; 37.7%), caspofungin (64/268; 23.9%), and voriconazole (49/268; 18.3%) were the most widely used first-line agents
  8. fAll patients who were catheterized when the first positive samples were collected
  9. gVariable included immunoglobulin and thymosin
  10. hAmong 268 ICI patients receiving anti-fungal therapy in China-SCAN study, 59 patients withdrew from or decided to forego comprehensive treatment, of whom 29 died in hospital and 30 were discharged at their requests. The ICU or hospital mortality rate listed here was based only on patients who died in hospital or completed treatment and were discharged at their physician’s discretion. The overall ICU mortality rate in empirical therapy, pre-emptive therapy, and targeted therapy groups decreased to 42 (29.6%), 26 (49.1%), and 27 (37.0%), respectively (P = 0.039); and the overall hospital mortality rate in these three groups decreased to 43 (30.3%), 27 (50.9%), and 29 (39.7%), respectively (P = 0.025) when all the 268 patients who received antifungal therapy were included