Risk Factors for Candidal Bloodstream Infections in Surgical Intensive Care Unit Patients: The NEMIS Prospective Multicenter Study

TLDR

The study aims to identify which antifungal agents are most protective and which high‑risk surgical ICU patients would benefit from prophylaxis. A prospective, multicenter cohort of all surgical ICU admissions >48 h over two years was used to assess risk factors for candidal bloodstream infections. Among 4,276 SICU patients, 42 candidal bloodstream infections occurred (0.98 per 1000 patient days, 1.42 per 1000 SICU days with central lines), with prior surgery, acute renal failure, parenteral nutrition, and triple‑lumen catheters independently increasing risk (RR 7.3–5.4) and antifungal therapy decreasing risk (RR 0.3).

Abstract

To assess risk factors for development of candidal blood stream infections (CBSIs), a prospective cohort study was performed at 6 sites that involved all patients admitted to the surgical intensive care unit (SICU) for >48 h over a 2-year period. Among 4276 such patients, 42 CBSIs occurred (9.82 CBSIs per 1000 admissions). The overall incidence was 0.98 CBSIs per 1000 patient days and 1.42 per 1000 SICU days with a central venous catheter in place. In multivariate analysis, factors independently associated with increased risk of CBSI included prior surgery (relative risk [RR], 7.3), acute renal failure (RR, 4.2), receipt of parenteral nutrition (RR, 3.6), and, for patients who had undergone surgery, presence of a triple lumen catheter (RR, 5.4). Receipt of an antifungal agent was associated with decreased risk (RR, 0.3). Prospective clinical studies are needed to identify which antifungal agents are most protective and which high-risk patients will benefit from antifungal prophylaxis.