Mortality rates and risk factors associated with nosocomial Candida infection in a respiratory intensive care unit.

To determine the incidence and mortality rate of nosocomial Candida infections (NCI) with respect to associated risk factors in the respiratory intensive care unit (RICU) patients. Data of 163 RICU patients were analyzed for NCI in 2006 retrospectively. Diagnosis of NCI; at least one Candida spp. was isolated in patients with severe sepsis, hospitalized > 1 day intensive care unit (ICU). NCI positive vs. NCI negative were compared with respect to invasive procedure, comorbidities, mortality. Risk factors were analyzed by logistic regression test. NCI positive in 26 (15.9%) patients were mean age: 65 +/- 15 years (female/male ratio: 8/18). Candida albicans/non-albicans ratio was 13/13. ICU stay was longer in NCI positive than NCI negative (48.2 +/- 7.5 days vs. 10.3 +/- 0.8 days; p< 0.001). Higher mortality rates were demonstrated in NCI positive (14.6% vs. 30.8%; p< 0.05). Risk factors for NCI were as follow: Invasive mechanical ventilations (IMV), central catheters and related infections, total parenteral nutrition, multiple antibiotics, ventilator associated tracheobronchitis (VAT) (p< 001 for all and, odd ratio: 95% CI: 6.27, 2.05-19.16; 28.3, 4.61-32.04; 10.93, 4.04-29.56; 2.12-88.98; 14.99, 5.6-40.08, respectively) and sepsis and ventilator associated pneumonia (VAP) (p< 0.01, 7.34, 1.66-32.35; 3.87, 1.42-10.52, respectively). Presence of catheters and related infections, IMV, multiple antibiotics use, parenteral nutrition, VAT, sepsis and VAP were founded as major risk factors for our patients with NCI. Because of longer ICU duration and higher mortality in NCI patients with treated antifungal drugs, risk factors must be evaluated carefully in the ICU.