BACKGROUND: The objective of this study was to assess the cumulative incidence of invasive candidiasis (IC) in intensive care units (ICUs) in Europe. METHODS: A multinational, multicenter, retrospective study was conducted in 23 ICUs in 9 European countries, representing the first phase of the candidemia/intra-abdominal candidiasis in European ICU project (EUCANDICU). RESULTS: During the study period, 570 episodes of ICU-acquired IC were observed, with a cumulative incidence of 7.07 episodes per 1000 ICU admissions, with important between-center variability. Separated, non-mutually exclusive cumulative incidences of candidemia and IAC were 5.52 and 1.84 episodes per 1000 ICU admissions, respectively. Crude 30-day mortality was 42%. Age (odds ratio [OR] 1.04 per year, 95% CI 1.02-1.06, p < 0.001), severe hepatic failure (OR 3.25, 95% 1.31-8.08, p 0.011), SOFA score at the onset of IC (OR 1.11 per point, 95% CI 1.04-1.17, p 0.001), and septic shock (OR 2.12, 95% CI 1.24-3.63, p 0.006) were associated with increased 30-day mortality in a secondary, exploratory analysis. CONCLUSIONS: The cumulative incidence of IC in 23 European ICUs was 7.07 episodes per 1000 ICU admissions. Future in-depth analyses will allow explaining part of the observed between-center variability, with the ultimate aim of helping to improve local infection control and antifungal stewardship projects and interventions.

1st Division Cotugno Hospital AO dei Colli Naples Italy

Bichat Réanimation médicale et des maladies infectieuses Medical ICU Paris France

C H Vila Nova de Gaia Espinho Vila Nova de Gaia Portugal

Clinical Microbiology and ATB Centre Institute of Medical Biochemistry and Laboratory Diagnostics General University Hospital Prague Czech Republic Department of Medical Microbiology Medical Faculty of Palackeho University Olomouc Czech Republic

Département d'Anesthésie Réanimation CHU Bichat Claude Bernard HUPNVS APHP Paris France

Département d'Anesthésie Réanimation CHU Bichat Claude Bernard HUPNVS APHP Paris France Université de Paris INSERM UMR 1152 Paris France

Department 1 of Internal Medicine University Hospital of Cologne and Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases Cologne Germany

Department of Anesthesia and Intensive Care University Hospital of Modena Modena Italy

Department of Anesthesiology and Intensive Care Medicine Heidelberg University Hospital Heidelberg Germany

Department of Biopathology and Medical Biotechnologies Section of Anesthesia Analgesia Intensive Care and Emergency Policlinico P Giaccone University of Palermo Palermo Italy

Department of Critical Care University Hospital Attikon Medical School University of Athens Athens Greece

Department of Diagnostics and Public Health Infectious Disease Unit University of Verona Verona Italy

Department of Emergency and Intensive Care Medicine Centro Hospitalar Universitário São João Faculdade de Medicina da Universidade do Porto e Grupo de Infecção e Sépsis Porto Portugal

Department of General Internal Medicine Medical Intensive Care Unit University Hospitals Leuven Leuven Belgium

Department of Health Sciences University of Genoa Genoa Italy

Department of Health Sciences University of Genoa Genoa Italy Health Planning unit Azienda Ligure Sanitaria della Regione Liguria Liguria Region Italy Health Planning unit Policlinic San Martino Hospital IRCCS Genoa Italy

Department of Health Sciences University of Genoa Genoa Italy Medical Direction Santa Corona Hospital ASL 2 Regional Health System of Liguria Pietra Ligure Italy

Department of Infectious Diseases Manchester University NHS Foundation Trust Wythenshawe Hospital

Department of Intensive Care and Anesthesiology Università Cattolica del Sacro Cuore Fondazione Policlinico Universitario Agostino Gemelli Rome Italy

Department of Intensive Care Medicine Multidisciplinary Intensive Care Research Organization St James's Hospital Dublin Ireland Hospital Clinic IDIBAPS CIBERes universidad de Barcelona Barcelona Spain

Department of Intensive Care Medicine University Hospital Brussels Brussels Belgium

Department of Intensive Care University Medical Center Groningen Groningen the Netherlands

Department of Laboratory Medicine and National Reference Centre for Mycosis University Hospitals of Leuven Leuven Belgium Department of Microbiology and Immunology KU Leuven Leuven Belgium

Department of Medical Sciences Infectious Diseases University of Turin Turin Italy

Department of Public Health and Infectious Diseases Sapienza University of Rome Rome Italy

Department of Surgical Oncological and Oral Science Section of Anesthesia Analgesia Intensive Care and Emergency Policlinico Paolo Giaccone University of Palermo Palermo Italy

Faculty of Biology Medicine and Health University of Manchester Manchester UK

G Gennimatas General Hospital of Thessaloniki Thessaloniki Greece

Health Planning unit Azienda Ligure Sanitaria della Regione Liguria Liguria Region Italy Health Planning unit Policlinic San Martino Hospital IRCCS Genoa Italy

Infectious Diseases Clinic Department of Medicine University of Udine and Santa Maria Misericordia Hospital Piazzale Santa Maria della Misericordia 15 33100 Udine Italy

Infectious Diseases Clinic Department of Medicine University of Udine and Santa Maria Misericordia Hospital Piazzale Santa Maria della Misericordia 15 33100 Udine Italy Department of Health Sciences University of Genoa Genoa Italy

Infectious Diseases Department Azienda Sanitaria Universitaria Integrata di Trieste Trieste Italy

Infectious Diseases Department Ospedale Civile SS Giovanni e Paolo Venice Italy

Infectious Diseases Unit Department of Medical and Surgical Science S Orsola Malpighi Hospital University of Bologna Bologna Italy

Institute of Infectious Diseases Fondazione Policlinico Universitario A Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy

Intensive Care Department Vrije Universiteit Brussel Brussels Belgium

Pole Anesthésie Réanimation SAMU Rouen University Hospital Rouen France

Radboud Center for Infectious Diseases Radboud University Medical Center Nijmegen The Netherlands

Servicio de Cuidados Críticos y Urgencias Hospital San Juan de Dios del Aljarafe Bormujos Sevilla Spain

Sorbonne Université Assistance Publique Hôpitaux de Paris Service de réanimation médico chirurgicale Hôpital Tenon 75020 Paris France

Université Paris Diderot Hopital Bichat Réanimation Medicale et Des Maladies Infectieuses Paris France UMR 1137 IAME Team 5 DeSCID Decision SCiences in Infectious Diseases Control and Care Inserm Univ Paris Diderot Sorbonne Paris Cité Paris France

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$a Bassetti, Matteo $u Infectious Diseases Clinic, Department of Medicine University of Udine and Santa Maria Misericordia Hospital, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy. matteo.bassetti@asuiud.sanita.fvg.it. Department of Health Sciences, University of Genoa, Genoa, Italy. matteo.bassetti@asuiud.sanita.fvg.it.

245    10

$a Incidence and outcome of invasive candidiasis in intensive care units (ICUs) in Europe: results of the EUCANDICU project / $c M. Bassetti, DR. Giacobbe, A. Vena, C. Trucchi, F. Ansaldi, M. Antonelli, V. Adamkova, C. Alicino, MP. Almyroudi, E. Atchade, AM. Azzini, N. Carannante, A. Carnelutti, S. Corcione, A. Cortegiani, G. Dimopoulos, S. Dubler, JL. García-Garmendia, M. Girardis, OA. Cornely, S. Ianniruberto, BJ. Kullberg, K. Lagrou, C. Le Bihan, R. Luzzati, MLNG. Malbrain, M. Merelli, AJ. Marques, I. Martin-Loeches, A. Mesini, JA. Paiva, M. Peghin, SM. Raineri, R. Rautemaa-Richardson, J. Schouten, P. Brugnaro, H. Spapen, P. Tasioudis, JF. Timsit, V. Tisa, M. Tumbarello, CHSB. van den Berg, B. Veber, M. Venditti, G. Voiriot, J. Wauters, P. Montravers,

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$a BACKGROUND: The objective of this study was to assess the cumulative incidence of invasive candidiasis (IC) in intensive care units (ICUs) in Europe. METHODS: A multinational, multicenter, retrospective study was conducted in 23 ICUs in 9 European countries, representing the first phase of the candidemia/intra-abdominal candidiasis in European ICU project (EUCANDICU). RESULTS: During the study period, 570 episodes of ICU-acquired IC were observed, with a cumulative incidence of 7.07 episodes per 1000 ICU admissions, with important between-center variability. Separated, non-mutually exclusive cumulative incidences of candidemia and IAC were 5.52 and 1.84 episodes per 1000 ICU admissions, respectively. Crude 30-day mortality was 42%. Age (odds ratio [OR] 1.04 per year, 95% CI 1.02-1.06, p < 0.001), severe hepatic failure (OR 3.25, 95% 1.31-8.08, p 0.011), SOFA score at the onset of IC (OR 1.11 per point, 95% CI 1.04-1.17, p 0.001), and septic shock (OR 2.12, 95% CI 1.24-3.63, p 0.006) were associated with increased 30-day mortality in a secondary, exploratory analysis. CONCLUSIONS: The cumulative incidence of IC in 23 European ICUs was 7.07 episodes per 1000 ICU admissions. Future in-depth analyses will allow explaining part of the observed between-center variability, with the ultimate aim of helping to improve local infection control and antifungal stewardship projects and interventions.

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$a Giacobbe, Daniele R $u Department of Health Sciences, University of Genoa, Genoa, Italy.

700    1_

$a Vena, Antonio $u Infectious Diseases Clinic, Department of Medicine University of Udine and Santa Maria Misericordia Hospital, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy.

700    1_

$a Trucchi, Cecilia $u Health Planning unit, Azienda Ligure Sanitaria della Regione Liguria (A.Li.Sa.), Liguria Region, Italy. Health Planning unit, Policlinic San Martino Hospital - IRCCS, Genoa, Italy.

700    1_

$a Ansaldi, Filippo $u Department of Health Sciences, University of Genoa, Genoa, Italy. Health Planning unit, Azienda Ligure Sanitaria della Regione Liguria (A.Li.Sa.), Liguria Region, Italy. Health Planning unit, Policlinic San Martino Hospital - IRCCS, Genoa, Italy.

700    1_

$a Antonelli, Massimo $u Department of Intensive Care and Anesthesiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.

700    1_

$a Adamkova, Vaclava $u Clinical Microbiology and ATB Centre, Institute of Medical Biochemistry and Laboratory Diagnostics, General University Hospital, Prague, Czech Republic. Department of Medical Microbiology, Medical Faculty of Palackeho University, Olomouc, Czech Republic.

700    1_

$a Alicino, Cristiano $u Department of Health Sciences, University of Genoa, Genoa, Italy. Medical Direction, Santa Corona Hospital, ASL 2 Regional Health System of Liguria, Pietra Ligure, Italy.

700    1_

$a Almyroudi, Maria-Panagiota $u Department of Critical Care, University Hospital Attikon, Medical School, University of Athens, Athens, Greece.

700    1_

$a Atchade, Enora $u Département d'Anesthésie-Réanimation, CHU Bichat-Claude Bernard, HUPNVS, APHP, Paris, France.

700    1_

$a Azzini, Anna M $u Department of Diagnostics and Public Health, Infectious Disease Unit, University of Verona, Verona, Italy.

700    1_

$a Carannante, Novella $u First Division, Cotugno Hospital, AO dei Colli, Naples, Italy.

700    1_

$a Carnelutti, Alessia $u Infectious Diseases Clinic, Department of Medicine University of Udine and Santa Maria Misericordia Hospital, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy.

700    1_

$a Corcione, Silvia $u Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy.

700    1_

$a Cortegiani, Andrea $u Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy.

700    1_

$a Dimopoulos, George $u Department of Critical Care, University Hospital Attikon, Medical School, University of Athens, Athens, Greece.

700    1_

$a Dubler, Simon $u Department of Anesthesiology and Intensive Care Medicine, Heidelberg University Hospital, Heidelberg, Germany.

700    1_

$a García-Garmendia, José L $u Servicio de Cuidados Críticos y Urgencias, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, Spain.

700    1_

$a Girardis, Massimo $u Department of Anesthesia and Intensive Care, University Hospital of Modena, Modena, Italy.

700    1_

$a Cornely, Oliver A $u Department I of Internal Medicine, University Hospital of Cologne and Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.

700    1_

$a Ianniruberto, Stefano $u Infectious Diseases Unit, Department of Medical and Surgical Science, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.

700    1_

$a Kullberg, Bart Jan $u Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.

700    1_

$a Lagrou, Katrien $u Department of Laboratory Medicine and National Reference Centre for Mycosis, University Hospitals of Leuven, Leuven, Belgium. Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.

700    1_

$a Le Bihan, Clement $u Bichat-Réanimation médicale et des maladies infectieuses, Medical ICU, Paris, France.

700    1_

$a Luzzati, Roberto $u Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.

700    1_

$a Malbrain, Manu L N G $u Department of Intensive Care Medicine, University Hospital Brussels (UZB), Jette, Belgium and Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium.

700    1_

$a Merelli, Maria $u Infectious Diseases Clinic, Department of Medicine University of Udine and Santa Maria Misericordia Hospital, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy.

700    1_

$a Marques, Ana J $u C.H. Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.

700    1_

$a Martin-Loeches, Ignacio $u Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland. Hospital Clinic, IDIBAPS,CIBERes, universidad de Barcelona, Barcelona, Spain.

700    1_

$a Mesini, Alessio $u Department of Health Sciences, University of Genoa, Genoa, Italy.

700    1_

$a Paiva, José-Artur $u Department of Emergency and Intensive Care Medicine, Centro Hospitalar Universitário São João, Faculdade de Medicina da Universidade do Porto e Grupo de Infecção e Sépsis, Porto, Portugal.

700    1_

$a Peghin, Maddalena $u Infectious Diseases Clinic, Department of Medicine University of Udine and Santa Maria Misericordia Hospital, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy.

700    1_

$a Raineri, Santi Maurizio $u Department of Biopathology and Medical Biotechnologies, Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico P. Giaccone, University of Palermo, Palermo, Italy.

700    1_

$a Rautemaa-Richardson, Riina $u Department of Infectious Diseases, Manchester University NHS Foundation Trust, Wythenshawe Hospital; and Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.

700    1_

$a Schouten, Jeroen $u Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.

700    1_

$a Brugnaro, Pierluigi $u Infectious Diseases Department, Ospedale Civile SS. Giovanni e Paolo, Venice, Italy.

700    1_

$a Spapen, Herbert $u Intensive Care Department, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.

700    1_

$a Tasioudis, Polychronis $u G. Gennimatas General Hospital of Thessaloniki, Thessaloniki, Greece.

700    1_

$a Timsit, Jean-François $u Université Paris Diderot/Hopital Bichat-Réanimation Medicale et Des Maladies Infectieuses, Paris, France. UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases, Control and Care, Inserm/Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.

700    1_

$a Tisa, Valentino $u Department of Health Sciences, University of Genoa, Genoa, Italy.

700    1_

$a Tumbarello, Mario $u Institute of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy.

700    1_

$a van den Berg, Charlotte H S B $u Department of Intensive Care, University Medical Center Groningen, Groningen, the Netherlands.

700    1_

$a Veber, Benoit $u Pole Anesthésie-Réanimation-SAMU, Rouen University Hospital, Rouen, France.

700    1_

$a Venditti, Mario $u Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.

700    1_

$a Voiriot, Guillaume $u Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de réanimation médico-chirurgicale, Hôpital Tenon, 75020, Paris, France.

700    1_

$a Wauters, Joost $u Department of General Internal Medicine, Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium.

700    1_

$a Montravers, Philippe $u Département d'Anesthésie-Réanimation, CHU Bichat-Claude Bernard, HUPNVS, APHP, Paris, France. Université de Paris, INSERM UMR 1152, Paris, France.

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