Impact of invasive fungal infection on outcomes of severe sepsis: a multicenter matched cohort study in critically ill surgical patients

Records for all admissions to 10 university hospital surgical intensive care units (ICUs) from December 2004 to November 2005 were reviewed. Patients who met criteria for severe sepsis were included. IFI was identified using established criteria based on microbiologic or histological evidence. A matched cohort study was conducted to analyze the relationship between IFI and outcomes of severe sepsis.A total of 318 patients with severe sepsis were enrolled during the study period, of whom 90 (28.3%) were identified as having IFI. A total of 100 strains of fungi (58% Candida albicans) were isolated from these patients. Independent risk factors for IFI in patients with severe sepsis included mechanical ventilation (>3 days), Acute Physiology and Chronic Health Evaluation score, coexisting infection with both Gram-positive and Gram-negative bacteria, and urethral catheterization (>3 days). Compared with the control cohort, IFI was associated with increased hospital mortality (P < 0.001), high hospital costs (P = 0.038), and prolonged stay in the ICU (P < 0.001) and hospital (P = 0.020).IFI is frequent in patients with severe sepsis in surgical ICUs and is associated with excess risk for hospital mortality, longer ICU and hospital stays, and greater consumption of medical resources.Invasive fungal infection (IFI) is a severe clinical complication in immunocompromised patients, such as neutropenic patients, recipients of bone marrow or solid organ transplants, cancer patients receiving chemotherapy, and HIV-infected patients. However, during the past two decades, with advances in diagnostic and therapeutic interventions, critically ill patients with lesser degrees of immunocompromise, especially those in surgical and neonatal intensive care units (ICUs), have emerged as another population at high risk for IFI [1-3].Sepsis is the body's systemic inflammatory response to infection. It is considered severe when it is associated with acute organ dysfunction. According to epide