Limits...
Septic shock due to candidemia: outcomes and predictors of shock development.

Guzman JA, Tchokonte R, Sobel JD - J Clin Med Res (2011)

Bottom Line: A high proportion of non-albicans Candida species causing fungemia (74%) was observed.High dose fluconazole was the most common initial treatment provided.Four patients died before receiving any antifungal treatment.

View Article: PubMed Central - PubMed

Affiliation: Section of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, USA.

ABSTRACT

Background: The present report describes the outcomes of a cohort of patients with Candida induced septic shock.

Methods: Retrospective analysis of individuals who had at least one positive blood culture for Candida species ≥ 48 h after ICU admission. Data from patients that developed septic shock within 48 hr of the positive blood culture were compared to non-shock candidemic patients. Patients with a concomitant bacteremia and/or endocarditis were excluded.

Results: Fifteen patients with Candida induced septic shock were studied and compared to 35 candidemic patients without shock. Overall mortality was 76% (87 % among those who had shock). A high proportion of non-albicans Candida species causing fungemia (74%) was observed. All patients with shock were receiving antibiotics but not antifungal treatment at the time of shock development, eight were on parenteral nutrition, six on steroids and nine had a cancer history. High dose fluconazole was the most common initial treatment provided. Four patients died before receiving any antifungal treatment. Time in ICU before the development of candidemia was identified as a predictor of shock development (higher chance if fungemia developed < 7 days after ICU admission).

Conclusions: Septic shock due to invasive candidiasis is a near fatal condition. No conventional risk factors were identified to predict shock development other than time (shorter) spent in ICU before the development of candidemia. We encourage clinicians to consider the initiation of appropriate empiric antifungal treatment in high-risk patients who develop septic shock while on antimicrobial treatment.

Keywords: Septic shock; Candidemia; Outcome; Predictor.

No MeSH data available.


Related in: MedlinePlus

Receiver operator curves for the three predictors with statistical significance. Closed circles: ROC for time in ICU prior to candidemia; Open circles: ROC for ICU length of stay (LOS); Open diamonds: ROC for hospital LOS
© Copyright Policy - open access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3140925&req=5

Figure 2: Receiver operator curves for the three predictors with statistical significance. Closed circles: ROC for time in ICU prior to candidemia; Open circles: ROC for ICU length of stay (LOS); Open diamonds: ROC for hospital LOS

Mentions: Table 3 shows odd ratios and confidence intervals for shock development for the parameters identified by univariate analysis. Time in ICU before the development of candidemia reached significance as predictor of shock development. Area under the receiver operating curve was 0.826 (Fig. 2). The threshold of < 7.2 days in ICU before the development of candidemia allowed a discrimination between shock development and no shock with a sensitivity of 73.3% and a specificity of 80.0%. A trend was also noted for hospital and ICU LOS prior to development of candidemia, the lack of statistical significance may be related to the limited sample size. Judging by the values of the Hosmer-Lemeshow and the likelihood ratio statistic, the model appears well calibrated.


Septic shock due to candidemia: outcomes and predictors of shock development.

Guzman JA, Tchokonte R, Sobel JD - J Clin Med Res (2011)

Receiver operator curves for the three predictors with statistical significance. Closed circles: ROC for time in ICU prior to candidemia; Open circles: ROC for ICU length of stay (LOS); Open diamonds: ROC for hospital LOS
© Copyright Policy - open access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3140925&req=5

Figure 2: Receiver operator curves for the three predictors with statistical significance. Closed circles: ROC for time in ICU prior to candidemia; Open circles: ROC for ICU length of stay (LOS); Open diamonds: ROC for hospital LOS
Mentions: Table 3 shows odd ratios and confidence intervals for shock development for the parameters identified by univariate analysis. Time in ICU before the development of candidemia reached significance as predictor of shock development. Area under the receiver operating curve was 0.826 (Fig. 2). The threshold of < 7.2 days in ICU before the development of candidemia allowed a discrimination between shock development and no shock with a sensitivity of 73.3% and a specificity of 80.0%. A trend was also noted for hospital and ICU LOS prior to development of candidemia, the lack of statistical significance may be related to the limited sample size. Judging by the values of the Hosmer-Lemeshow and the likelihood ratio statistic, the model appears well calibrated.

Bottom Line: A high proportion of non-albicans Candida species causing fungemia (74%) was observed.High dose fluconazole was the most common initial treatment provided.Four patients died before receiving any antifungal treatment.

View Article: PubMed Central - PubMed

Affiliation: Section of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, USA.

ABSTRACT

Background: The present report describes the outcomes of a cohort of patients with Candida induced septic shock.

Methods: Retrospective analysis of individuals who had at least one positive blood culture for Candida species ≥ 48 h after ICU admission. Data from patients that developed septic shock within 48 hr of the positive blood culture were compared to non-shock candidemic patients. Patients with a concomitant bacteremia and/or endocarditis were excluded.

Results: Fifteen patients with Candida induced septic shock were studied and compared to 35 candidemic patients without shock. Overall mortality was 76% (87 % among those who had shock). A high proportion of non-albicans Candida species causing fungemia (74%) was observed. All patients with shock were receiving antibiotics but not antifungal treatment at the time of shock development, eight were on parenteral nutrition, six on steroids and nine had a cancer history. High dose fluconazole was the most common initial treatment provided. Four patients died before receiving any antifungal treatment. Time in ICU before the development of candidemia was identified as a predictor of shock development (higher chance if fungemia developed < 7 days after ICU admission).

Conclusions: Septic shock due to invasive candidiasis is a near fatal condition. No conventional risk factors were identified to predict shock development other than time (shorter) spent in ICU before the development of candidemia. We encourage clinicians to consider the initiation of appropriate empiric antifungal treatment in high-risk patients who develop septic shock while on antimicrobial treatment.

Keywords: Septic shock; Candidemia; Outcome; Predictor.

No MeSH data available.


Related in: MedlinePlus