In this episode, I’ll discuss the risk factors for invasive candida infection in critically ill patients.
The sepsis guidelines recommend using empiric antifungal therapy for adults with sepsis or septic shock at high risk of fungal infection. However, the risk assessment is not well defined in the guidelines beyond a list of 28 different possible factors that could put a patient at higher than normal risk of fungal infection.
A group of authors in the journal Chest recently published a systematic review and meta-analysis of available data to better characterize risk factors for invasive candida infection in critically ill patients.
The authors looked at 34 studies and 29 different risks for candida infection.
After adjustment, five risk factors had particularly high odds ratios for candida infection:
Receipt of broad-spectrum antibiotics for more than 72 hours (odds ratio 5.6)
Receipt of blood transfusion (odds ratio 4.9)
Candida colonization (odds ratio 4.7)
Placement of a central venous catheter (odds ratio 4.7)
Receipt of total parenteral nutrition (odds ratio 4.6)
In addition, 17 other risk factors also had statistically significant odds ratios for increased risk of invasive candida infection:
Mechanical ventilation
Bacteremia
HIV
Sepsis
Renal replacement therapy
Shock
Colonization index
Abdominal surgery
Hematological diseases
Neutropenia
Transplantation
Immunosuppression
Corticosteroids
Renal diseases
Malignancy
Any surgery
Diabetes mellitus
The difficulty with translating this information to clinical practice is that the absolute increase in risk by any one factor is small. This means that to use these risk factors would result in either a very large percentage of patients being treated with empiric antifungal therapy unnecessarily or an extremely complex risk assessment tool would need to be developed.
The way forward that has the most chance of applicability to clinical practice is likely to combine risk factor analysis with biomarkers for candida infection, although the optimal strategy for this approach has not been identified.
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These high odds ratio risk factors for invasive candida infection in critically ill pts are extremely helpful. Are you aware of any studies that feature high odds ratio risk factors for MDROs, MRSA, and/or Pseudomonas?
Hi Chris, I am not aware of any studies but I will keep an eye out and share them in an episode if I find them!
Thank you, Pharmacy Joe. I greatly appreciate it!