Epidemiology of invasive fungal infections in the intensive care unit: results of a multicenter Italian survey (AURORA Project) View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2013-03-06

AUTHORS

M. T. Montagna, G. Caggiano, G. Lovero, O. De Giglio, C. Coretti, T. Cuna, R. Iatta, M. Giglio, L. Dalfino, F. Bruno, F. Puntillo

ABSTRACT

PurposeThe aims of this study are to evaluate the epidemiology of invasive fungal infections (IFIs) in patients admitted to an intensive care unit (ICU) in Southern Italy and the in vitro antifungal susceptibility of isolates.MethodsA surveillance program was implemented in 18 ICUs. IFI cases were recorded using a standardized form.ResultsA total of 105 episodes of IFIs occurred in 5,561 patients during the 18-month study. The main infections were caused by yeasts, more than filamentous fungi (overall incidence of 16.5 cases per 1,000 admissions and 2.3 cases per 1,000 admissions, respectively). The overall crude mortality rate was high (42.8 %), particularly for mold infections (61.5 %). All yeast infections were Candida bloodstream infections. Over half (59.8 %) were caused by Candida non-albicans, with C. parapsilosis being the most common (61.8 %). In the multivariate model, trauma admission diagnosis, prolonged stay in the ICU, and parenteral nutrition were independently associated with candidemia due to C. parapsilosis [odds ratio (OR) 3.5, (1.8–5.2); OR 3.5, (1.02–3.5); OR 3.6, (1.28–6.99), respectively]. Among mold infections, 12 patients suffered from invasive pulmonary aspergillosis, with Aspergillus fumigatus as the predominant pathogen (41.7 %). One case of brain scedosporiosis was identified. Overall, azoles and echinocandins resistance was uncommon.ConclusionsCandida non-albicans species are the most frequent cause of candidemia in ICU patients. Mold infections are associated with a high mortality rate. This study confirms the importance of the epidemiological surveillance on IFIs in the ICU setting for documenting species distribution and antimicrobial susceptibility patterns to guide therapeutic choices. More... »

PAGES

645-653

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s15010-013-0432-0

DOI

http://dx.doi.org/10.1007/s15010-013-0432-0

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1009487949

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/23463186


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30 schema:description PurposeThe aims of this study are to evaluate the epidemiology of invasive fungal infections (IFIs) in patients admitted to an intensive care unit (ICU) in Southern Italy and the in vitro antifungal susceptibility of isolates.MethodsA surveillance program was implemented in 18 ICUs. IFI cases were recorded using a standardized form.ResultsA total of 105 episodes of IFIs occurred in 5,561 patients during the 18-month study. The main infections were caused by yeasts, more than filamentous fungi (overall incidence of 16.5 cases per 1,000 admissions and 2.3 cases per 1,000 admissions, respectively). The overall crude mortality rate was high (42.8 %), particularly for mold infections (61.5 %). All yeast infections were Candida bloodstream infections. Over half (59.8 %) were caused by Candida non-albicans, with C. parapsilosis being the most common (61.8 %). In the multivariate model, trauma admission diagnosis, prolonged stay in the ICU, and parenteral nutrition were independently associated with candidemia due to C. parapsilosis [odds ratio (OR) 3.5, (1.8–5.2); OR 3.5, (1.02–3.5); OR 3.6, (1.28–6.99), respectively]. Among mold infections, 12 patients suffered from invasive pulmonary aspergillosis, with Aspergillus fumigatus as the predominant pathogen (41.7 %). One case of brain scedosporiosis was identified. Overall, azoles and echinocandins resistance was uncommon.ConclusionsCandida non-albicans species are the most frequent cause of candidemia in ICU patients. Mold infections are associated with a high mortality rate. This study confirms the importance of the epidemiological surveillance on IFIs in the ICU setting for documenting species distribution and antimicrobial susceptibility patterns to guide therapeutic choices.
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36 schema:keywords Aspergillus fumigatus
37 C. parapsilosis
38 Candida bloodstream infections
39 Candida non-albicans
40 ICU patients
41 IFI cases
42 Italian survey
43 Italy
44 ResultsA total
45 admission diagnosis
46 aim
47 antifungal susceptibility
48 antimicrobial susceptibility patterns
49 aspergillosis
50 azoles
51 bloodstream infections
52 candidemia
53 care unit
54 cases
55 cause
56 choice
57 crude mortality rate
58 diagnosis
59 distribution
60 epidemiological surveillance
61 epidemiology
62 episodes
63 episodes of IFI
64 filamentous fungi
65 form
66 frequent cause
67 fumigatus
68 fungal infections
69 fungi
70 half
71 high mortality rate
72 importance
73 infection
74 intensive care unit
75 invasive fungal infections
76 invasive pulmonary aspergillosis
77 isolates
78 main infections
79 model
80 mold infections
81 mortality rate
82 multicenter Italian survey
83 multivariate model
84 non-albicans
85 non-albicans species
86 nutrition
87 overall crude mortality rate
88 parapsilosis
89 parenteral nutrition
90 pathogens
91 patients
92 patterns
93 predominant pathogen
94 program
95 pulmonary aspergillosis
96 rate
97 resistance
98 results
99 scedosporiosis
100 southern Italy
101 species
102 species distribution
103 standardized form
104 stay
105 study
106 surveillance
107 surveillance program
108 survey
109 susceptibility
110 susceptibility patterns
111 therapeutic choice
112 total
113 units
114 yeast
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