Risk Factors for development of invasive candidiasis in critically ill patients: A prospective observational study in intensive care unit of a tertiary hospital

Background: Majority of invasive candidiasis in critically ill patients was developed after admission to intensive care unit. The aim of this study was to identify risk factors for development of invasive candidiasis among patients admitted to intensive care unit, especially considering the timing of laboratory, microscopic, and culture examinations. Materials and Methods: This was a prospective observational study in which critically ill patients were assessed on the first, fifth, and ninth day since admission to intensive care unit. Potential risk factors were demographic and clinical characteristic, clinical managements profile proportions, laboratory profile (leukocyte, platelet, erythrocyte sedimentation rate, C-reactive protein and procalcitonin), morphological change (from yeast to hypae or pseudohyphae in microscopic examination) and colonization increase (from serial culture examination). Results: A total of 115 subjects enrolled in this study. Multivariate analysis identified older age (HR 2.8, 95% CI 0.8-8.9), parenteral nutrition (HR 3.1, 95% CI 0.77-12.3), central venous catheter (HR 1.7, 95% CI 0.43-6.67), corticosteroid (HR 2.8, 95% CI 0.53-14.8), procalcitonin day-5 (HR 3.1, 95% CI 0.89-10.8), morphology change in the axilla and rectal swab (HR 5.1, 95% CI 1.6-18.51), and morphology change and colonization increase in rectal swab day-9 (HR 4.3, 95% CI 1.0-18.02) as independent risk factors of invasive candidiasis. Conclusion: In addition to several typical risk factors, procalcitonin test on day-5 as well as serial microscopic and culture examinations were associated with the development of invasive candidiasis, therefore potentially help in the diagnosis and treatment of critically ill patients in intensive care unit.