Current guidelines recommend empiric antifungal therapy in sepsis patients with high risk of invasive Candida infection. However, many different risk factors have been derived from multiple studies. These risk factors lack specificity and broad application would render the majority of ICU patient eligible for empiric antifungal therapy.
What risk factors for invasive Candida infection can be identified by a systematic review and meta-analysis?
We searched PUBMED, Web of Science, ScienceDirect, BMC and Cochrane and extracted the raw and adjusted odds ratio for each risk factor associated with invasive Candida infection. We calculated pooled odds ratios for risk factors present in more than one study.
We included 34 studies in our meta-analysis resulting in the assessment of 29 possible risk factors. Risk factors for invasive Candida infection included demographic factors, comorbid conditions, and medical interventions. While demographic factors do not play a role for the development of invasive Candida infection, comorbid conditions (e.g. HIVU, Candida colonization) and medical interventions have a significant impact. The risk factors associated with the highest risk for ICI were broad spectrum antibiotics (OR 5.6 [95% CI 3.6-8.8]), blood transfusion (OR 4.9 [95% CI 1.5-16.3]), Candida colonization (OR 4.7 [95% CI 1.6-14.3]), central venous catheter (OR 4.7 [95% CI 2.7-8.1]) and total parenteral nutrition (OR 4.6 [95% CI 3.3-6.3]). However, dependence between the various risk factors is probably high.
Our systematic review and meta-analysis identified patient and treatment related factors that were associated with the risk for the development of invasive Candida infection in the intensive care unit. Most of the factors identified were either related to medical interventions during intensive care or to comorbid conditions.

Copyright © 2021. Published by Elsevier Inc.