Abstract
Background
Candida species are among the most frequent causative agents of health care–associated bloodstream infections, with mortality >40% in critically ill patients. Specific populations of critically ill patients may present peculiar risk factors related to their reason for intensive care unit admission. The primary objective of the present study was to assess the predictors of candidemia after open heart surgery.
Methods
This retrospective, matched case–control study was conducted in 8 Italian hospitals from 2009 to 2016. The primary study objective was to assess factors associated with the development of candidemia after open heart surgery.
Results
Overall, 222 patients (74 cases and 148 controls) were included in the study. Candidemia developed at a median time (interquartile range) of 23 (14–36) days after surgery. In multivariable analysis, independent predictors of candidemia were New York Heart Association class III or IV (odds ratio [OR], 23.81; 95% CI, 5.73–98.95; P < .001), previous therapy with carbapenems (OR, 8.87; 95% CI, 2.57–30.67; P = .001), and previous therapy with fluoroquinolones (OR, 5.73; 95% CI, 1.61–20.41; P = .007). Crude 30-day mortality of candidemia was 53% (39/74). Septic shock was independently associated with mortality in the multivariable model (OR, 5.64; 95% CI, 1.91–16.63; P = .002). No association between prolonged cardiopulmonary bypass time and candidemia was observed in this study.
Conclusions
Previous broad-spectrum antibiotic therapy and high NYHA class were independent predictors of candidemia in cardiac surgery patients with prolonged postoperative intensive care unit stay.
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Details
1 Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
2 Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy; Division of Cardiac Surgery, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
3 Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
4 Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
5 Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
6 Infectious Diseases ISMETT IRCCS, Palermo, Italy
7 Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
8 Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
9 Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
10 ICLAS - GVM Care & Research, Rapallo, Italy
11 Maria Cecilia Hospital - GVM Care & Research, Cotignola, Italy
12 Division of Cardiac Surgery, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
13 Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy