Screening, prevalence, and risk factors for secondary localization during candidemia in intensive care unit patients: the French CandidICU multicenter study

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BACKGROUND: Candidemia is a life-threatening fungal infection in intensive care unit (ICU) patients that can be complicated by secondary localization (SL). However, the prevalence, risk-factors, and outcomes of patients with secondary localization during candidemia remain poorly explored. METHODS: The CandidICU study was a retrospective multicenter cohort study conducted in 16 French ICUs. All adult patients hospitalized from 01-2015 to 01-2023 for candidemia were enrolled. We assessed the prevalence and risk-factors for SL. In addition, we explored the clinical course according to the screening and occurrence of SL. RESULTS: Among 492 patients hospitalized in ICU with at least one positive blood culture for Candida sp., 376 were screened for SL (76.4%). At least one SL was diagnosed in 82 patients (21.8%). Competing risk analysis identified the SAPSII score and the duration of positive blood cultures as independent risk factors for SL (sdHR 1.01 [95%CI 1.00-1.02]; p = 0.031 and sdHR 1.05 [95%CI 1.02-1.08]; p = 0.003, respectively). Age and Candida glabrata infection were protective factors against SL (sdHR 0.98 [95%CI 0.97-1.00]; p = 0.016 and sdHR 0.38 [95%CI 0.15-0.99]; p = 0.048, respectively). Finally, patients with SL received longer antifungal treatment (18 [11-30] versus 14 [6-18] days; p < 0.001) and had a higher rate of antifungal escalation (27.8% versus 12.3%; p = 0.002). CONCLUSIONS: In this cohort, 76·4% of ICU patients with candidemia were screened for SL and at least one SL was diagnosed in 21·8%. The severity at ICU admission and duration of positive blood cultures were identified as independent risk factors for SL, whereas age and Candida glabrata infection were protective. Finally, the screening and occurrence of SL were associated with significant changes in the management of patients.

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