Outcome and potentially modifiable risk factors for candidemia in critically ill burns patients: A matched cohort study.

BACKGROUND: Patients with extensive burns are at risk of developing candidemia.

OBJECTIVES: To identify potentially modifiable risk factors and outcomes of candidemia in critically ill burns patients.

PATIENTS AND METHODS: Retrospective matched cohort study including adult burns patients. Patients who developed candidemia were matched with burns patients with Candida spp colonization and sepsis or septic shock without candidemia in a ratio of 1:3 (same severity scores and colonization index). Univariate and multiple regression analyses were performed.

RESULTS: Of 130 severely burned patients with Candida spp colonization and at least one episode of sepsis or septic shock, 14 were diagnosed with candidemia. In the candidemia group, patients had a median (IQR) total burns surface area (TBSA) of 57(38-68) %, SAPSII of 43(36-58) and ABSI of 11(8-13). Multiple regression analysis showed that only duration of prior antibiotic therapy was independently associated with candidemia. ICU-mortality was higher in the candidemia group (71% versus 35%(p=0.02)). The log-rank test for 28-day mortality comparing patients with candidemia treated with an empirical strategy versus a curative strategy did not reach significance (p=0.056).

CONCLUSIONS: Burns patients having received recent antibiotherapy have a higher risk of candidemia. Antifungal strategies did not influence outcome in this series. This article is protected by copyright. All rights reserved.