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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
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BMC Infectious Diseases

ISSN: 1471-2334

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