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

Département d'Anesthésie Réanimation CHU Bichat Claude Bernard HUPNVS APHP 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 Infectious Diseases Manchester University NHS Foundation Trust Wythenshawe Hospital; and Faculty of Biology Medicine and Health University of Manchester Manchester UK

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

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 Medical Microbiology Medical Faculty of Palackeho University Olomouc Czech Republic

Department of Medical Sciences Infectious Diseases University of Turin Turin Italy

Department of Microbiology and Immunology KU Leuven Leuven Belgium

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

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

Hospital Clinic IDIBAPS CIBERes universidad de Barcelona Barcelona Spain

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 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

Medical Direction Santa Corona Hospital ASL 2 Regional Health System of Liguria Pietra Ligure Italy

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

UMR 1137 IAME Team 5 DeSCID Decision SCiences in Infectious Diseases Control and Care Inserm Univ Paris Diderot Sorbonne Paris Cité Paris France

Université de Paris INSERM UMR 1152 Paris France

Université Paris Diderot Hopital Bichat Réanimation Medicale et Des Maladies Infectieuses Paris France

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