Candidemia is a life threatening complication for patients who are severely ill. The infection is difficult to recognize, thus leading to delayed treatments. Our goal is to describe the incidence of fungemia and the utilization of antifungal medications in critically ill trauma patients.
A retrospective cohort study of trauma patients admitted to the Surgical Intensive Care Unit (SICU) from January 1, 2003 to December 31, 2007 is performed. Inclusion criterias were patients > 18 years of age, Injury Severity Score (ISS) > 25, Acute Physiology and Chronic Health Evaluation (APACHE) II score > 25, and a SICU stay > 3 days. Fungemia is define as either positive fungal blood cultures or a colonization index greater than 0.5.
Of the 1393 SICU admissions, 93 met inclusion criterias. 23 patients had positive fungal culture. Individuals who had positive fungal cultures had statistically significant findings: higher ISS (39 versus 29), longer mechanical ventilator dependence (19 versus 11 days), longer SICU stay (20 versus 13 days), and longer hospitalization (34 versus 24 days). Both groups (fungal positive versus fungal negative) were similar in the rate of bacterial infection (96% versus 94%), and length of central venous catheters days (19 versus 12). Of the 93 patients, antifungal treatments were utilized on 19 patients, 10 in the positive fungal culture group and 9 in negative fungal culture group. Fluconazole was used at doses ranging from 100mg to 800mg administered both oral and intravenous, and the length of administration ranged from 1 to 10 days. The overall incidence of fungal infection was 1%.
A higher incidence of fungemia was observed as compared to that reported by the literature of 0.16–0.5%. Individuals with fungemia had higher morbidity than those who did not, however more death was found in the fungal negative group.
Is the difference between the two groups due to their injuries? Does prophylaxis with antifungal medications provide a benefit? Further prospective studies are needed to answer these questions.
Sandra Saldana, No Financial Disclosure Information; No Product/Research Disclosure Information