Candidemia is a potentially lethal and common infection in the intensive care unit (ICU). A number of risk factors for invasive candidiasis have been identified in previous studies. Our objective is to determine if there is a difference in the risk factor profile of medical ICU (MICU) and surgical ICU (SICU) patients.
A retrospective analysis was conducted at a large community-based teaching hospital. Subjects had positive blood cultures for Candida species and were admitted to the MICU and SICU over a two-year time period. Patients with known malignancies or other immunocompromising states were excluded. Demographic variables, Simplified Acute Physiological Score (SAPS), and known risk factors for candidemia were compared between MICU and SICU patients. Chi-square analysis and independent-sample t-tests were applied.
Forty-three patients were included for analysis. MICU patients had significantly higher SAPS scores (57.8 vs. 41.1, p= 0.005.). SICU patients had a greater number of antibiotic days (42 vs. 18.38, p<0.001) and received a larger number of antibiotics (4.68 vs. 3.04, p=0.002). SICU patients were on mechanical ventilation longer (19.37 vs. 8.5 days, p= 0.02) and had longer hospital stays (56.7 versus 35.3 days, p=0.03). SICU patients tended to have greater frequencies of other risk factors including parenteral nutrition and central venous catheters. There was no difference in mortality rate between the two populations.
Significant differences exist between MICU and SICU patients who develop candidemia. The observed trend in our study is that SICU patients had higher frequencies of traditional risk factors, while MICU patients had worse physiological indices.
Traditional risk factors for the development of candidemia need further analysis to determine whether they are equally applicable to both MICU and SICU patients.
Stephen Heitner, None.