EPIDEMIOLOGY OF INVASIVE MYCOSIS IN ICU PATIENTS - A PROSPECTIVE MULTICENTER STUDY IN 435 NON-NEUTROPENIC PATIENTS

Objective: To determine the epidemiological and clinical significance of invasive fungal infections in non-neutropenic patients in intensive care who stay longer than 10 days on the intensive care unit (ICU). D esign: Prospective epidemiological multicenter study over a period of 11 months, based on strict clinical, bacteriological, serological and histological criteria. Setting: Six surgical and two medical ICUs unit s in five university and two municipal hospitals. Patients: 435 non-ne utropenic patients from medical and surgical ICUs with an ICU stay of more than 10 days. Measurements ann main results: A new occurrence of invasive mycosis (3 sepsis/ 4 peritonitis/ 1 disseminated candidiasis) , corresponding to the protocol conditions with onset after day 10 in the ICU, was detectable in 2.0 % (95 % confidence interval 0.85 to 3.8 %) of the 409 patients who could be assessed. Candida species were id entified as an infection-relevant pathogen in all cases. The most impo rtant risk factor for the development of an invasive mycosis was the o nset of peritonitis by the day 11 in the ICU (odds ratio 11.3; p = 0.0 03). A fungal colonization was detected in 64 % of patients (Candida s pecies 56 %, Aspergillus 4 %, and other fungi). Six of 8 patients with an invasive mycosis died on the ICU; ICU mortality in patients with f ungal colonization was 31 % and in noncolonized patients 26 %. Serolog ical tests were not helpful clinically. The sensitivity was 88 % for t he Candida HAT (haemagglutination test) (threshold titer > 1:160), 100 % for the Candida IFT (immunofluorescence test) (threshold titer > 1: 80), and 50 % for the Candida Antigen Test (Candtec Ramco, threshold t iter greater than or equal to 1:8), and the specificity was 26, 6, and 73 %, respectively. The specificity for the Aspergillus HAT (threshol d titer > 1:10) was 29 %. Conclusions: Invasive mycoses are rare in no n-neutropenic ICU patients, even after a longer stay in the intensive care unit; fungal colonization, on the other hand, is frequently detec table. The mortality of invasive mycosis - even with systemic antimyco tic therapy- was high, the mortality in patients with fungal colonizat ion was not significantly increased compared to that in noncolonized p atients. The serological test procedures, Candida HAT, Candida IFT, an d the Candida Ramco Antigen Test, had a low specificity and were not h elpful in diagnosing relevant invasive mycosis.