Candida Infections in ICU Surgical Patients in Europe

Update after Council Meeting 2012: The study is finished, the manuscript is in preparation.

In 2005, 17 countries have declared their willingness to participate in this ECMM Intensive Care Unit (ICU) study in surgical patients. Prof. Lena Klingspor (Karolinska Institute, Stockholm, Sweden) is ECMM coordinator of the study.

An initial meeting of the ECMM ICU working group was held in Berlin, October 22, 2005, at the Trends in Medical Mycology 2 conference. The study started September 1st, 2006 and is extended to 31st of December, 2008.
The study was designed to include 75 patients from each of 18 participating countries for a total of 1350 patients. The aims of the survey are:

A) To expand our knowledge of the characteristics of surgical patients in the ICU with invasive Candida infection:
1. Type of preceding surgery
2. Underlying disease(s)
3. Risk factors
4. Candida species causing infection
5. Treatment

B) To gain more knowledge of the different diagnostic procedures and their sensitivity, i.e.:
6. The sensitivity of different blood culture systems and media to detect candidemia.
7. The detection time (in hours) for the different media to detect candidemia.
8. To determine if the source of blood for blood culture influences the sensitivity of detection of candidemia, i.e. peripheral vein or artery, CVL or Porth-a-Catheter.
9. The sensitivity of different blood culture systems and different media to detect candidemia with a concordant bacterial sepsis.
10. The possible sensitivity of different blood culture systems and different media to detect different Candida species.
11. To get more information about invasive Candida infections in the absence of a positive blood culture for Candida spp. For example: to characterise blood culture negative patients with other signs of invasive Candida infection, e.g. a positive culture for Candida from an abdominal abscess.

C) If possible, to determine the patient groups who could benefit from prophylaxis. The goal for the study is to include 75 patients with invasive Candida infection (blood from culture positive and/or positive cultures from a normally sterile body site) from each participating country. The study was open for inclusion for a 2-year period.

ECMM Working Group participants

Country

Co-ordinator

Austria

Birgit Willinger

Bulgaria

Todor Kantardjiev

Czeck Republic

Petr Hamal

Denmark

Maiken Cavling Arendrup

Finland

Juha Salonen

France

Reneé Grillot

Germany

Markus Ruhnke

Greece

Aristea Velegraki

Hungary

Elisabeth Nagy

Italy

Anna Maria Tortorano

Netherlands

Jacques Meis

Norway

Peter Gaustad

Poland

Agnieska Misiewska

Spain

Javier Pemán

Sweden

Lena Klingspor

Turkey

Emel Tümbay

UK

Christopher Kibbler, Rosemary Barnes

So far, patients included in the study are 372 from 12 out of 18 participating countries: Italy 112 cases, Austria 63, Greece 60, Czech 33, Sweden 30, Spain 22, Netherlands 15, Germany 12, France 10, Finland 6, UK (Cardiff) 5, Switzerland 4. Additional 75 patients from Denmark will be included.

Dr. N Longley (UK) presented data collected from representative European ICUs concerning the use of different diagnostic procedures and anti-infective practices, in order to provide the background of the current survey study (Poster 216 of TIMM-3: ECMM survey of risk factors and practice in the management of invasive yeast infections in European surgical intensive care units).

Prof. A.M. Tortorano presented data from Italy (TIMM-3 Oral communication 07: ECMM/FIMUA survey on invasive fungal infections in ICU: ad interim analysis after 12 months). The Working Group has received an unrestricted grant from Merck Sharp & Dohme. Preliminary data of the Working Group will be presented by Dr. Klingspor in Istanbul, during the IUMS Congress.

From Mycology Newsletter 2006, P. 5-6, 2007, P. 7