Risk factors for candidal bloodstream infections in surgical intensive care unit patients: The NEMIS Prospective Multicenter Study

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 CBS Is per 1000 admissions). The overall incidence was 0.98 CBSIs per 1000 pati ent days and 1.42 per 1000 SICU days with a central venous catheter in plac e. In multivariate analysis, factors independently associated with increase d risk of CBSI included prior surgery (relative risk [RR], 7.3), acute rena l failure (RR, 4.2), receipt of parenteral nutrition (RR, 3.6), and, for pa tients 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 antifunga l agents are most protective and which high-risk patients will benefit from antifungal prophylaxis.