A prospective, observational, multicentre study of invasive candidosis (IC) in surgical patients in intensive care units (ICUs) was conducted from 2006 to 2008 in 72 ICUs in 14 European countries. A total of 779 patients (62.5% males, median age 63 years) with IC were included. The median rate of candidaemia was 9 per 1000 admissions. In 10.8% the infection was already present at the time of admission to ICU. Candida albicans accounted for 54% of the isolates, followed by Candida parapsilosis 18.5%, Candida glabrata 13.8%, Candida tropicalis 6%, Candida krusei 2.5%, and other species 5.3%. Infections due to C. krusei (57.9%) and C. glabrata (43.6%) had the highest crude mortality rate. The most common preceding surgery was abdominal (51.5%), followed by thoracic (20%) and neurosurgery (8.2%). Candida glabrata was more often isolated after abdominal surgery in patients ≥60 years, and C. parapsilosis was more often isolated in neurosurgery and multiple trauma patients as well as children ≤1 year of age. The most common first-line treatment was fluconazole (60%), followed by caspofungin (18.7%), liposomal amphotericin B (13%), voriconazole (4.8%) and other drugs (3.5%). Mortality in surgical patients with IC in ICU was 38.8%. Multivariate analysis showed that factors independently associated with mortality were: patient age ≥60 years (hazard ratio (HR) 1.9, p 0.001), central venous catheter (HR 1.8, p 0.05), corticosteroids (HR 1.5, p 0.03), not receiving systemic antifungal treatment for IC (HR 2.8, p <0.0001), and not removing intravascular lines (HR 1.6, p 0.02).

Centre of Clinical Microbiology University College London and Department of Medical Microbiology Royal Free Hospital London UK

Département de Parasitologie Mycologie Inserm U995 Centre Hospitalier Régional Universitaire de Lille Université Lille Nord de France Lille France

Department of Clinical Microbiology Karolinska Institutet Karolinska University Hospital Stockholm Sweden

Department of Clinical Microbiology La Fe University Hospital Valencia Spain

Department of Clinical Microbiology University of Szeged Szeged Hungary

Department of Infectious Diseases URSZ Mycology National Institute of Health Dr Ricardo Jorge Lisbon Portugal

Department of Medical Microbiology and Infectious Diseases Canisius Wilhelmina Hospital; Department of Medical Microbiology Radboud University Nijmegen Medical Centre Nijmegen The Netherlands

Department of Medical Microbiology Hacettepe University Medical School Ankara Turkey

Department of Medicine Charité Universitätsmedizin Berlin Campus Charité Mitte Berlin Germany

Department of Medicine Päijät Häme Central Hospital Lahti Finland

Department of Microbiology Faculty of Medicine and Dentistry Palacky University Olomouc Czech Republic

Dipartimento Scienze Biomediche per la Salute Università degli Studi di Milano Milano Italy

Division of Clinical Microbiology Department of Laboratory Medicine Medical University of Vienna Vienna Austria

Mycology Research Laboratory Department of Microbiology Medical School National and Kapodistrian University of Athens Athens Greece

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