Candidemia in nonneutropenic critically ill patients:: Risk factors for non-albicans Candida spp.

Objective., The objective of this study was to determine the clinical features associated with candidemia caused by non-albicans Candida spp. and with potentially fluconazole-resistant Candida spp. (C. glabrata and C. krusei) among candidemic intensive care unit patients. Design: The authors conducted a nationwide prospective cohort study. Setting: The study was conducted in Australian intensive care units. Patients. All patients with intensive care unit-acquired candidemia over a 3-yr period were included in the study. Measurements. Clinical risk factors occurring up to 30 days before candidemia, Candida spp. associated with candidernia, and outcomes were determined. Risk factors associated with either non-albicans Candida spp. or with potentially fluconazole-resistant Candida spp. (C. glabrata or C. krusei) were assessed using multivariate logistic regression. Main Results: Among 179 episodes of intensive care unit acquired candidemia, C. albicans accounted for 62%, C. glabrata 18%, C. krusei 4%, and other Candida spp. 16%. Independently significant variables associated with non-albicans Candida bloodstream infection included recent prior gastrointestinal surgery (adjusted odds ratio, 2.87; 95% confidence interval, 1.68-4.91) and recent prior systemic antifungal exposure (4.6; 1.36-15.53). Those associated with potentially fluconazole-resistant candidemia included recent prior gastrointestinal surgery (3.31; 1.796.11) and recent prior fluconazole exposure (5.47; 1.23-24.32). No significant differences in outcomes were demonstrated for nonalbicans or potentially fluconazole-resistant candidemia. Conclusions. Among candidemic intensive care unit patients, prior gastrointestinal surgery and systemic antifungal exposure were significantly associated with both a non-albicans Candida spp. and a potentially fluconazole-resistant Candida spp.