ICU Acquired Fungal Infection in Critically Ill Patients with Severe Sepsis: Incidence, Outcomes and Epidemiological Characteristics
|Keywords||Severe sepsis ICU Fungal infections Epidemiology Multi-center study|
[Objective] : To determine the period incidence and epidemiologic characteristics characteristics of ICU acquired fungal infection in critically ill patients with severe sepsis in multiple medical centers in China; to analyze the effect of fungal infection on these patients.[Method] : Retrospective cohort study of surgical ICU patients with severesepsis in 10 university hospitals in 6 provinces in China. All admissions diagnosed severe sepsis with a longer than 48 hour stay in participating ICUs between December 1st, 2004 and November 30th, 2005 were enrolled. Relavant information was recorded and put into a database.[Results]: According to the study criteria, 230 patients were included into thestudy cohort. Sixty patients acquired at least one episodes of fungal infection in ICU and 68 strains of fungi were isolated, including 37 Candida albicans (54.4%), 13 Candida tropicalis (19.1%), 10 Candida glabrata (14.7%) and other species (11.8%). The most commen sites of fungal infection were lung, blood stream, abdomen and urinary system. Overall hospital mortality for severe sepsis patients with fungal infection was higher than those without fungal infection (55.0% vs. 37.6%, p<0.05).Old age, infected by both gram positive and negative bacteria and administration of broad-spectrum antibiotics may be associated with ICU acquired fungal infection in severe sepsis patients. The median days of stay in ICU was 18d (10d-34.75d) and the average hospital cost was ￥16882 ±14697 per patient and ￥497.5 ± 285.4 per patient per day.[Conclusion]: This multi-center study reveals that ICU acquired fungal infection is common in critically ill patients with severe sepsis and contributed to longer ICU stay and higher expenditure. In the process of diagnosis and treatment of severe sepsis in ICU, more attentions or early intervention should be give to those patients at high risk of ICU acquired fungal infection.