Valutazione dei fattori di rischio per lo sviluppo di candidemia dopo interventi di cardiochirurgia maggiore

Background: Candida species are among the most frequent causative agents of healthcare-associated bloodstream infections, with mortality higher than 40% in critically ill patients. Specific populations of critically ill patients may present peculiar risk factors related to their reason for intensive care unit admission. The primary objective of the present study was to assess the predictors of candidemia after open heart surgery. Methods: This retrospective, matched, case-control study was conducted in 8 Italian hospitals from 2009 to 2016. The primary study endpoint was development of candidemia after open surgery. Crude mortality within 30 days after the onset of candidemia in cases was a secondary study endpoint. Results: Overall, 222 patients (74 cases and 148 controls) were included in the study. Candidemia developed at a median time of 23 days after surgery (interquartile range 14-36). In multivariable analysis, independent predictors of candidemia were New York Heart Association class equal or greater than III (odds ratio [OR] 23.81, 95% confidence intervals [CI] 5.73-98.95, p<0.001), previous therapy with carbapenems (OR 8.87, 95% CI 2.57-30.67, p=0.001), and previous therapy with fluoroquinolones (OR 5.73, 95% CI 1.61-20.41, p=0.007). Crude 30-day mortality of candidemia was 53% (39/74). Septic shock was independently associated with mortality in the multivariable model (OR 5.64, 95% CI 1.91-16.63, p=0.002). No association between prolonged cardiopulmonary bypass time and candidemia was observed in this study. Conclusions: Previous broad-spectrum antibiotic therapy and high NYHA class were independent predictors of candidemia in cardiac surgery patients with prolonged postoperative ICU stay.