Journal of Anesthesia and Intensive Care

Volume 2, Issue 1 (2021)

Research Article - Open Access
The Association of Candida Auris Invasive Candidiasis with Hospital Mortality-A Propensity Score Weighted Cohort Analysis and Clinical Predictive Model Development

Paula Carmona1,2*, Guido Mazzinari1,2, Iratxe Zarragoikoetxea1,2, Clara Pascual3, María Victoria Johannessen3, Marta López-Cantero1, Miguel Ángel Chiveli1, Pilar Argente4

1Consultant of Anesthesiology and Critical Care Medicine, HuiP la Fe, Valencia, Spain

2Research Group in Perioperative Medicine, Biomedical Research Institute la Fe, Valencia, Spain

3Resident of Anesthesiology and Critical Care Resident at HuiP La Fe, Valencia, Spain

4Associate Professor of Valencia University, Head of Department of Anesthesiology and Critical Care at HUiP La Fe, Valencia, Spain

*Corresponding Author:
Paula Carmona García
MD, PhD, MSc, Hospital Universitario y Politécnico la Fe, Avinguda de Fernando Abril Martorell 106 ,46026, Valencia, Spain.
Tel: +34 669344529
E-mail: paulac_g@hotmail.com

Received date: June 11, 2021; Accepted date: June 22, 2021; Published date: June 29, 2021

Citation: Carmona P, Mazzinari G, Zarragoikoetxea I, Pascual C, Johannessen MV, López-Cantero M, et al. The Association of Candida Auris Invasive Candidiasis with Hospital Mortality - A Propensity Score Weighted Cohort Analysis and Clinical Predictive Model Development. J Anest Inten Care. 2021;2(1):13-20.

Copyright: © 2021 Carmona P, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Objectives: The main objective was to assess if invasive candidiasis (IC) caused by Candida Auris is associated with higher mortality compared to non-Auris IC etiology. The secondary objective was to identify which factors are associated with mortality in a population of surgical intensive care unit (SICU) patients with IC.

Methods: Retrospective propensity score weighted cohort study and predictive risk model estimation with elastic net regularization.

Results: 107 patients developed IC. 61 (57%) had a C.auris etiology and 46 (43%) had other Candida spp etiology. The overall hospital mortality rate was 48.6% and 49.2% and 47.8% in the C.auris and other Candida spp. IC cohort respectively. The association of C.auris–related IC with mortality was not significant (odds ratio (OR) 1.12 [95%CI 0.46 to 2.75, P = 0.99]. The C.auris–related IC survival time ratio was not significant [1.47 95%CI 0.85 to 2.55, P=0.99]. Predictive risk model feature selection selected the following variables as predictors: age, APACHE II score, renal replacement therapy, septic shock, pulmonary, kidney, and hemodynamic complications during ICU stay. The predictive model Area Under Curve (AUC) was 0.88 [95%CI 0.82 to 0.95, P < 0.001]

Conclusions: Mortality in patients admitted with IC in SICU remains high. C.auris etiology was not associated with increased hospital mortality nor higher survival time compared to non–Auris–related IC. The development of septic shock with hemodynamic, respiratory, and renal compromise are the main risk factors for mortality.

Keywords

Invasive candidiasis; Candidemia; Candida Auris; Critical Care; Risk Factors; Multidrug Resistant Yeast

Intruduction

Candida Auris is an emerging yeast with high transmissibility, high antifungal treatment resistance, and difficult microbiological identification [1, 2]. Containing C.auris outbreaks in intensive care units (ICUs) is arduous as it colonizes patients indefinitely, generates invasive disease, and persists in the healthcare environment [3].

Most patients who develop invasive candidiasis (IC) are fragile, often immunosuppressed, and with severe comorbidities. Indeed, surgical ICU (SICU) patients are particularly at risk of developing IC since they frequently undergo aggressive surgeries, receive multiple antibiotic treatments or artificial nutrition, require extracorporeal circulatory assistance devices, and suffer from severe metabolic diseases [4].

While IC is associated with high overall mortality, it is unclear whether a C.auris–related IC is associated with higher mortality compared to an IC caused by other Candida species (spp.). Also, while risk factors associated with IC occurrence have been studied [5], the factors associated with increased mortality in patients with IC remain to be elucidated. Identifying mortality predictors could be the key to implementing specific measures to reduce IC mortality.

This study aimed to assess whether IC caused by C.auris is associated with increased mortality and to identify mortality predictors in patients with IC. Our primary objective was the association of C.auris IC etiology with mortality compared to non–Auris IC etiology. Our secondary objective was to build a predictive model with mortality predictors in patients with IC.



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