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Cited by 661Antifungal resistance and susceptibilityNosocomial Infections in ICUInfective Endocarditis Diagnosis and Management

Risk Factors for Candidal Bloodstream Infections in Surgical Intensive Care Unit Patients: The NEMIS Prospective Multicenter Study

Blumberg, Henry M., Jarvis, William R., Soucie, J. Michael, Edwards, Jack E., Patterson, Jan E., Pfaller, Michael A., Rangel‐Frausto, M. Sigfrido, Rinaldi, Michael G. +4 more·2001·Clinical Infectious Diseases
DOI 10.1086/321811
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Abstract

To assess risk factors for development of candidal blood stream infections (CBSIs), a prospective cohort study was performed at 6 sites that involved all patients admitted to the surgical intensive care unit (SICU) for >48 h over a 2-year period. Among 4276 such patients, 42 CBSIs occurred (9.82 CBSIs per 1000 admissions). The overall incidence was 0.98 CBSIs per 1000 patient days and 1.42 per 1000 SICU days with a central venous catheter in place. In multivariate analysis, factors independently associated with increased risk of CBSI included prior surgery (relative risk [RR], 7.3), acute renal failure (RR, 4.2), receipt of parenteral nutrition (RR, 3.6), and, for patients who had undergone surgery, presence of a triple lumen catheter (RR, 5.4). Receipt of an antifungal agent was associated with decreased risk (RR, 0.3). Prospective clinical studies are needed to identify which antifungal agents are most protective and which high-risk patients will benefit from antifungal prophylaxis.

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  • Limited data from resource-limited settings suggest that timely administration of antimicrobials in patients with sepsis and septic shock is beneficial and potentially feasible.

    “Limited data from resource-limited settings suggest that timely administration of antimicrobials in patients with sepsis and septic shock is beneficial and potentially feasible (121-126).”

    From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [124]

    The Results (p. 6) examine antibiotic exposure and candidal bloodstream infection risk, not the timing of antimicrobial treatment for sepsis or septic shock. The Discussion (pp. 8–9) addresses antifungal therapy in surgical ICU patients, but does not assess its timely administration or feasibility in resource-limited settings. Searches for those terms and concepts found no passage addressing the attributed claim. (LLM, conf=0.76)

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  • In a multicenter study on risk factors in surgical patients, the incidence of fungal infections increased from 0.98/1,000 to 1.42/1,000 SICU days when a central venous catheter was in place.

    “In a multicenter study on risk factors in surgical patients, the incidence of fungal infections increased from 0.98/1,000 to 1.42/1,000 SICU days when a central venous catheter was in place [34].”

    From Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: part I. Epidemiology and diagnosis (2009) · cites this paper as [34]

  • Variables associated with invasive candidiasis include high APACHE II score, exposure to broad-spectrum antibiotics, cancer chemotherapy, mucosal colonization by Candida spp, pancreatitis, indwelling vascular catheters (especially central venous catheter), total parenteral nutrition, neutropenia, immune suppression therapy, prior surgery (especially gastrointestinal surgery), renal failure or haem

    “Variables that have been associated with IC include high APACHE II score, exposure to broad spectrum antibiotics, cancer chemotherapy, evidence of mucosal colonization by Candida spp, pancreatitis, indwelling vascular catheters (especially central venous catheter [CVC]), administration of total parenteral nutrition, neutropenia, immune suppression therapy, prior surgery (especially gastro”

    From Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting (2011) · cites this paper as [69]

  • C. parapsilosis is able to form biofilms on catheters and other implanted devices, can spread nosocomially by hand carriage, and can persist in the hospital environment.

    “C. parapsilosis is notorious for the ability to form biofilms on catheters and other implanted devices (26, 38, 56, 80, 121, 122, 129, 269), for nosocomial spread by hand carriage, and for persistence in the hospital environment (38, 80, 122, 129, 262).”

    From Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem (2007) · cites this paper as [26]

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Research works printed but not linked: 5

  1. [6]6. Bross J, Talbot GH, Maislin G, Hurwitz S, Strom BL. Risk factors for nosocomial candidemia: a case-control study. Am J Med 1989 ; 87: 614-20.
  2. [8]8. Wey SB, Mori M, Pfaller MA, Woolson RF, Wenzel RP. Risk factors for hospital-acquired candidemia. Arch Intern Med 1989 ; 149:2349-53.
  3. [12]12. Schwartz RS, Mackintosh FR, Schrier SL, Greenberg PL. Multivariate analysis of factors associated with invasive fungal disease during remission-induction therapy for acute myelogenous leukemia. Cancer 1984 ; 53:411-9.
  4. [19]19. Rangel-Frausto MS, Wiblin T, Blumberg HM, et al. National Epidemiology of Mycosis Survey (NEMIS): variations in rates of candidal bloodstream infections in seven surgical ICUs and six neonatal ICUs. Clin Infect Dis 1999 ; 29:253-8.
  5. [44]44. Pelz R, Lipsett PA, Swoboda S, et al. Do surveillance cultures predict fungal infection in critically ill patients? In: Proceedings and abstracts of the Annual Meeting of the Infectious Diseases Society of America (Denver). Alexandria, VA: Infectious Diseases Society of America, 1998 .

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Authors
Blumberg, H. M., Jarvis, W. R., Soucie, J. M., Edwards, J. E., Patterson, J. E., Pfaller, M. A., Rangel‐Frausto, M. S., Rinaldi, M. G., Saiman, L., Wiblin, R. T., Wenzel, R. P., & the NEMIS Study Group
Affiliations
  • Grady Memorial Hospital (US)
  • Centers for Disease Control and Prevention (US)
  • Emory University (US)
  • University of California, Los Angeles (US)
  • The University of Texas at San Antonio Health Science Center (US)
  • University of Iowa (US)
  • Columbia University Irving Medical Center (US)
  • Virginia Commonwealth University (US)
Corresponding author
Blumberg, Henry M.
ORCID
Venue
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2001-07-15
Volume
33
Issue
2
Pages
177-186
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
DOI
10.1086/321811
OpenAlex
W2169453316
Cited by
661
References
49
Citations by year
2026: 1 · 2025: 8 · 2024: 7 · 2023: 14 · 2022: 14 · 2021: 22 · 2020: 25 · 2019: 20 · 2018: 23 · 2017: 27 · 2016: 25 · 2015: 27 · 2014: 25 · 2013: 25 · 2012: 31
FWCI
18.66
Type
journal article
Language
en
Open access
closed
Locations
  • Clinical Infectious Diseases (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
  • Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
Keywords
Candida, surgical intensive care unit, risk factors, central venous catheters, triple-lumen catheter, parenteral nutrition, acute kidney injury, prior surgery, antifungal prophylaxis, antifungal agents, incidence, nosocomial infections
MeSH terms
Adolescent, Adult, Aged, Antifungal Agents, Candida, Candidiasis, Child, Child, Preschool, Critical Care, Female, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Opportunistic Infections, Prospective Studies, Risk Factors, United States, Multivariate Analysis, Fungemia

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