Systemic candidiasis in intensive care units: a multicenter, matched-cohort study.

OBJECTIVE: To determine the impact of systemic candidiasis on the mortality and length of hospital stay of intensive care unit (ICU) patients and the associated workload.

DESIGN: Multicenter, retrospective, matched-cohort study.

SETTING: Data were retrieved from a computerized database that prospectively collected clinical data submitted by 32 ICUs in the Paris, France area.

PATIENTS: A total of 149 stays with systemic candidiasis, including 104 candidemia, on ICU admission were identified in a 3-year period (1995-1997) among 49,063 admissions (3 per 1,000 admission). A total of 121 cases were matched with patients with no evidence of systemic Candida infection during the hospitalization period under study (same ICU, date of ICU admission, age, sex, simplified acute physiology score (SAPS II), location of the patient before admission, type of admission).

RESULTS: Patients with systemic candidiasis had longer ICU length of stays than controls (25 vs 10 d; P =.001) with a relative risk for death of 2.27 (95% confidence interval, 1.64-3.11; P =.001). There was no difference between patients with systemic candidiasis with or without positive blood culture.

CONCLUSIONS: Systemic Candida infections increased mortality and morbidity in severely ill patients. Optimizing management of such infections is imperative.