Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Organización social, dinámicas culturales e identidades de las poblaciones afrocolombianas del Pacifico y suroccidente de un contexto en movilidad y urbanización.

IP 1106-10-231-95Faltan Documentos de trabajo Nos. 8-9, 16-18, 21, 26-32. Incluye ficha tecnica del informe final.Informe final -- Documento de trabajo No.1. Dinamica sociodemografica, mercado laboral y pobreza urbana en Cali durante las decadas del 80 y 90 / Fernando Urrea Giraldo--Documentode trabajo No.2. Tipologia de familias migrantes de la Costa Pacifica en la ciudad de Cali /Fernando Urrea Giraldo, Santiago Arboleda Quiñonez, Javier Arias Mejia -- Documento de trabajo No.3.Caracteristicassociodemograficas y sociolaborales de la migracion de Costa Pacifica a la ciudad de Cali / FernandoUrrea Giraldo -- Documento de trabajo No.4. El uso de datos cualitativos y cuantitativos, transversales ylongitudinales en los estudios de migracion / Fernando Urrea Giraldo -- Documento de trabajo No.5. Mercadosycirculacion de tierras en medio campesino contemporaneo : una propuesta metodologica / Odile Hoffmann --Documento de trabajo No.6. Una aplicacion del analisis armonico cualitativo : la tipologia de trayectorias individuales/ Olivier Barbary -- Documento de trabajo No.7. Urbanizacion y construccion de identidades de laspoblaciones afrocolombianas de la region pacifica colombiana / Fernando Urrea Giraldo, Pedro Quintin Quilez -- Documento de trabajo No.10. Acerca de genealogias y memorias / Pedro Quintin Quilez -- Documentodetrabajo No.11. Puerto Tejada : de nucleo urbano de proletariado agroindustrial a ciudad dormitorio / FernandoUrrea Giraldo, Teodora Hurtado Saa -- Documento de trabajo No.12. Carnaval colombien, violence bresilienneetvice-versa :une piste de recherche / Michel Agier -- Documento de trabajo No.13. Sisben de Tumaco : una aproximacion cartografica a los datos / O. Hoffmann -- Documento de trabajo No.14. Las bases de datosgeoreferenciados del proyecto: Movilidad, urbanizacion e identidades de las poblaciones afrocolombianasenel Pacifico suroccidental : elementos cartograficos / Olivier Pissoat -- Documento de trabajo No.15.Tabulaciondel censo de poblacion y vivienda de 1993 en Cali / Olivier Barbary, Hector Fabio Ramirez -- Documento de trabajo No.19. La violence dans le carnaval : fictions et realites sud-americaines / Michel Agier-'- Documento de trabajo No.20. Les malheurs d'arlequin : metissage, carnaval et identite / Michel Agier --Documento de trabajo No.22. Territorialidad y derechos de propiedad en el rio Mejicano, (Tumaco, Nariño)/ Nelly YulissaRivas ; directora Odile Hoffmann -- Documento de trabajo No.23. Aproximacion a la dinamica politicade un pueblo del Pacifico : el caso de Guapi / Carlos Efren Agudelo A. -- Documento de trabajo No.24. Compte-Rendu de mission en France et au Mexique, 23 mai-7 juin 1998 / Odile Hoffmann -- Documento de trabajo No.25.Las tierras de las comunidades negras en el Pacifico colombiano : interpretaciones de la ley, estrategiasdelos actores / Michel Agier, Odile Hoffmann ; traducido por Adelaida Abadia, Carlos Agudelo -- Documentodetrabajo No.33. Encuesta movilidad, urbanizacion e identidades de las poblaciones afrocolombianas : manualde recoleccion /Virginia Robayo, Olivier Barbary -- Documento de trabajo No.34. Encuesta movilidad, urbanizacion eidentidadesde las poblaciones afrocolombianas : manual de critica y codificacion / Olivier Barbary -- Documento de trabajo No.35. Encuesta movilidad, urbanizacion e identidades de las poblaciones afrocolombianas:programasde correcciones y control de consistencias / Alexander Estacio y Hector Fabio Ramirez -'- documento de trabajo No.36. Encuesta movilidad, urbanizacion e identidades de las poblaciones afrocolombianas:diccionario de variables / Stephanie Bruyneel, Alexander Estacio -- Documento de trabajo No.37. Tabulacion delcenso de poblacion y vivienda de 1993 en Cali; Octubre de 1997 / Olivier Barbary, Hector Fabio Ramirez yotros'-- DOCUMENto de trabajo No.38. La movilizacion identitaria y el recurso de la memoria (Nariño, Pacifico colombiano) / Odile Hoffmann ; traducido por Monica Silva Pabon -- Documento de trabajo No.39. Patrones sociodemograficos, vivienda y niveles educativos en una ciudad dormitorio : el caso del municipio de Yumbo / FernandoUrrea Giraldo, Hector Fabio Ramirez -- Documento de trabajo No.40. La ciudad desnuda : emergencia de una nuevacondicion humana / Michel Agier -- Documento de trabajo No.41. Mesure et realite de la segmentation socio-raciale : une enquete sur les menages afrocolombiens a Cali / Olivier Barbary -- Documento de trabajo No.42. Poblacion negra yla cuestion identitaria en America Latina / Peter Wade -- Documento de trabajo No.43. Natures, identites, territoires : remarques sur l'analyse sociologique des mobilisations environnementales / Jean LouisFabiani -- Documento de trabajo No. 44. Patrones sociodemograficos, pobreza y mercado laboral en Cali (Documentode trabajopara el Banco Mundial) / Fernando Urrea Giraldo, Carlos Humberto Ortiz Quevedo -- Documentode trabajo No.45. Metodologia de la encuesta sociodemografica en Cali / redactado por Oliver Barbary ;conlaparticipacion de Stephanie Bruynel, Alexander Ramirez.(CIDSE. Documentos de trabajo ; 50) -- Los dramas de los lazosde sangre yde parentesco / Pedro Quintin;Quilez. -- Cali : Universidad del Valle, 2000. -- 54 p. :il.;27 cm. --(CIDSE. Documentos ; 51) -- Los;dramas de los lazos de sangre y de parentesco / Pedro QuintinQuilez. -- Cali : Universidad del Valle, 2000.; 54 p. : il. ; 27 cm. -- (CIDSE. Documentos de trabajo ;51)-'- Espaciosregionales, movilidad y;urbanizacion, dinamicas culturales e identidades en las poblaciones afrocolombianas del Pacifico sur y Cali.;Una perspectiva integrada / Michel Agier ... [et al.]. --Cali:Universidad del Valle, 2000. -- 89 p. : il. ;27 cm. -- (CIDSE. Documentos de trabajo ; 52) -- CAPITULO(S) ENLIBRO: Territorialidades y alianzas :;construccion y activacion de espacios locales en el Pacifico /Odile Hoffmann. -- p. 75-93. -- En: De montes,; Perdida de lugar, despojo y urbanizacion : un estudio sobrelos desplazados en Colombia / Michel Agier y;Odile Hoffmann. -- p. 104-126. -- En: Desplazados, migracionesinternas yreestructuraciones territoriales /;editado por Fernando Cubides y Camilo Dominguez. -- Bogotá: Universidad Nacional de Colombia, c1999. -- 484;p. : il. ; 21 cm. -- ISBN 9588063027 -- Poblacion afrocolombianay no afrocolombiana en Cali : segregacion,;diferenciales sociodemograficos y condiciones de vida / OliverBarbary, Hector Fabio Ramirez y Fernando Urrea.; p. 301-336. -- En: Desplazados, migraciones internas yreestructuraciones territoriales / editado por;Fernando Cubides y Camilo Dominguez. -- Bogotá : Universidad Nacional de Colombia, c1999. -- 484 p. : il. ; 21;LIBRO(S): Tumaco : haciendo ciudad : historia, identidad ycultura / Michel Agier ... [et al.]. -- Cali :;Universidad del Valle ; Bogotá : Instituto Colombiano de Antropologia ; Paris : Instituto de Investigacion;para el Desarrollo, 1999. -- 290 p. : 21 cm. -- ISBN 958671556'-- DOCUMENTO(S): Desencuentros en la costa :;la construccion de espacios y sociedades en el litoral Pacificocolombiano/ Odile Hoffmann. -- Cali :;Universidad del Valle, 1997. -- 34 p. : il. ; 22 cm. -- (CIDSE.Documentosde trabajo ; 33). -- ISSN 01225944; Familia y vereda en rio Mejicano (Tumaco), revision dealgunas nociones/ Odile Hoffmann. -- Cali :;rios y ciudades : territorios e identidades de la gente negraenColombia/ editado por Juana Camacho y;Eduardo Restrepo. -- Bogotá : Fundación Natura : Ecofondo: Instituto Colombiano de Antropologia, c1999. --;354 p. : il. ; 21 cm. -- ISBN 9589571255 -- Modalidades deacceso a la tierra en el Pacifico nariñense : rio;Mejicano,Tumaco / Nelly Rivas. -- p. 95-105. -- En: De montes,rios y ciudades : territorios e identidades de;la gente negra en Colombia / editado por Juana Camacho y EduardoRestrepo.-- Bogotá : Fundación Natura :;Ecofondo : Instituto Colombiano de Antropologia, c1999. --354p. : il. ;21 cm. -- Memorias y relatos de;lugares : a proposito de una migrante de la costa PacificaenCali / PedroQuintin. -- p. 245-262. -- En: De;montes, rios y ciudades : territorios e identidades de lagentenegra en Colombia / editado por Juana Camacho;y Eduardo Restrepo. -- Bogotá : Fundación Natura : Ecofondo :Instituto Colombiano de Antropologia, c1999. --;354 p. : il. ; 21 cm. -- Trabajando con la cultura : grupos derap e identidad negra en Cali / Peter Wade. --;p. 263-286. -- En: De montes, rios y ciudades : territorios eidentidadesde la gente negra en Colombia /;editado por Juana Camacho y Eduardo Restrepo. -- Bogotá :Fundación Natura: Ecofondo : Instituto Colombiano;de Antropologia, c1999. -- 354 p. : il. ; 21 cm. -- Imagenes sobre las transformaciones sociales en un pueblo;de negros : el caso de Puerto Tejada / Fernando Urrea y TeodoraHurtado. -- p. 297-334. -- En: De montes, rios;y ciudades : territorios e identidades de la gente negra en Colombia / editado por Juana Camacho y Eduardo;cm. -- Dinamica del poblamiento y algunas caracteristicasde losasentamientos populares con poblacion;afrocolombiana en el oriente de Cali / Fernando Urrea y FernandoMurillo.-- p. 337-405. -- En: Desplazados,;migraciones internas y reestructuraciones territoriales /editado por Fernando Cubides y Camilo Dominguez. --;Bogotá : Universidad Nacional de Colombia, c1999. -- 484 p. :il. ; 21 cm.'-- Puerto Tejada : de nucleo urbano;de proletariado agroindustrial a ciudad dormitorio / FernandoUrrea y Teodora Hurtado . -- p. 197-242. -- En:;Puerto Tejada 100 años / editado por Francisco U. ZuluagaR. --Puerto Tejada : Alcaldia Municipal, c1997. --;297 p. : il. ; 31 cm. -- ISBN 9583306436 -- L'invention delaville : banlieues, townships, invasions et;favelas / Michel Agier. -- Paris : Editions des Archives Contemporaines, c1999. -- 176 p. ; 22 cm. -- ISBN;9057090147 -- ARTICULO(S) EN REVISTA: Organizacion social,dinamicas culturales e identidades de las;poblaciones afrocolombianas del Pacifico y suroccidente enuncontexto demovilidad y urbanizacion / Odile;Hoffman y Pedro Quintin. -- En: Boletin socioeconomico. --No.31 (mayo 1999); p. 134-140. -- ISSN 01205242 --;Dinamica sociodemografica, mercado laboral y pobreza en Cali durante las decadas de los años 80 y 90 /;Fernando Urrea G. -- En: Coyuntura social. -- No. 17 (nov.1997); p. 105-164. -- ISSN 01212532 -- Redes;familiares entre migrantes de la Costa Pacifica a Cali / Fernando Urrea, Santiago Arboleda, Javier Arias. --;En: Revista colombiana de antropologia. -- Vol. 35 (ene.-dic.1999); p. 180-241. -- ISSN 04866525.;Universidad del Valle, 1998. -- 33 p. : il. ; 22 cm. -- (CIDSE.Documentosde trabajo ; 36) -- Afrocolombianos;en el area metropolitana de Cali. Estudios sociodemograficos /Olivier Barbary ... [et al.]. -- Cali :;Universidad del Valle, 1999. -- 98 p. : il. ; 27 cm. -- (CIDSE.Documentosde trabajo ; 38) -- Hacer politica;en el Pacifico sur : algunas aproximaciones / Carlos Agudelo,Odile Hoffmann, Nelly Rivas. -- Cali :;Universidad del Valle, 1999. -- 83 p. : il. ; 27 cm. -- (CIDSE.Documentos de trabajo ; 39) -- Imagenes de;las culturas negras del Pacifico colombiano / Alfredo Vanin ...[et al.].-- Cali : Universidad del Valle,;1999. -- 63 p. : il. ; 27 cm. -- (CIDSE. Documentos de trabajo;40) -- Practicas espaciales y construccion;territorial en el Pacifico nariñense : el rio Mejicano, municipio de Tumaco / Nelly Yulissa Rivas. -- Cali :;Universidad del Valle, 1999. -- 86 p. : il. ; 27 cm. -- (CIDSE.Documentosde trabajo ; 41) -- Poblaciones;negras en Colombia (compilacion bibliografica) / Eduardo Restrepo. -- Cali: Universidad del Valle, 1999. --;67 p. ; 27 cm. -- (CIDSE. Documentos de trabajo ; 43) -- Construccion de redes familiares entre migrantes de;la costa Pacifica y sus descendientes en Cali / Fernando UrreaGiraldo, Santiago Arboleda Quiñonez, Javier;Arias Mejia. -- Cali : Universidad del Valle, 2000. -- 55p. :il ; 27 cm.-- (CIDSE: Documentos de trabajo ;48) -- Relaciones interraciales, sociabilidades masculinasjuveniles y segregacion laboral de la poblacion;Restrepo. -- Bogotá : Fundación Natura : Ecofondo : InstitutoColombiano de Antropologia, c1999. -- 354 p. :;il. ; 21 cm. -- Etnologia y compromiso / Michel Agier. --p. 335-349. -- En: De montes, rios y ciudades :;territorios e identidades de la gente negra en Colombia /editado por Juana Camacho y Eduardo Restrepo. --;Bogotá : Fundación Natura : Ecofondo : Instituto Colombiano deAntropologia, c1999. -- 354 p. : il. ; 21 cm.;afrocolombiana en Cali / Pedro Quintin Quilez, Hector Fabio Ramirez, Fernando Urrea Giraldo. -- Cali :;Universidad del Valle, 2000. -- 83 p. : il. ; 27 cm. -- (CIDSE.Documentosde trabajo ; 49) -- Impactos de la;Ley 70 y dinamicas politicas locales de las poblaciones afrocolombianas :estudios de caso / Nelly Yulissa;Rivas, Teodora Hurtado Saa, Carlos Efren Agudelo. -- Cali: Universidad del Valle, 2000. -- 139 p. ; 27 cm. -

Efficacy and safety of tenecteplase in combination with enoxaparin, abciximab, or unfractionated heparin: The ASSENT-3 randomised trial in acute myocardial infarction

Background: Current fibrinolytic therapies fail to achieve optimum reperfusion in many patients. Low-molecular-weight heparins and platelet glycoprotein IIb/IIIa inhibitors have shown the potential to improve pharmacological reperfusion therapy. We did a randomised, open-label trial to compare the efficacy and safety of tenecteplase plus enoxaparin or abciximab, with that of tenecteplase plus weight-adjusted unfractionated heparin in patients with acute myocardial infarction. Methods: 6095 patients with acute myocardial infarction of less than 6 h were randomly assigned one of three regimens: full-dose tenecteplase and enoxaparin for a maximum of 7 days (enoxaparin group; n=2040), half-dose tenecteplase with weight-adjusted low-dose unfractionated heparin and a 12-h infusion of abciximab (abciximab group; n=2017), or full-dose tenecteplase with weight-adjusted unfractionated heparin for 48 h (unfractionated heparin group; n=2038). The primary endpoints were the composites of 30-day mortality, in-hospital reinfarction, or in-hospital refractory ischaemia (efficacy endpoint), and the above endpoint plus in-hospital intracranial haemorrhage or in-hospital major bleeding complications (efficacy plus safety endpoint). Analysis was by intention to treat. Findings: There were significantly fewer efficacy endpoints in the enoxaparin and abciximab groups than in the unfractionated heparin group: 233/2037 (11.4%) versus 315/2038 (15.4%; relative risk 0.74 [95% CI 0.63-0.87], p=0.0002) for enoxaparin, and 223/2017 (11.1%) versus 315/2038 (15.4%; 0.72 [0.61-0.84], p&lt;0.0001) for abciximab. The same was true for the efficacy plus safety endpoint: 280/2037 (13.7%) versus 347/2036 (17.0%; 0.81 [0.70-0.93], p=0.0037) for enoxaparin, and 287/2016 (14.2%) versus 347/2036 (17.0%; 0.84 [0.72-0.96], p=0.01416) for abciximab. Interpretation: The tenecteplase plus enoxaparin or abciximab regimens studied here reduce the frequency of ischaemic complications of an acute myocardial infarction. In light of its ease of administration, tenecteplase plus enoxaparin seems to be an attractive alternative reperfusion regimen that warrants further study

Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study

Item does not contain fulltextOBJECTIVES: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. DESIGN: A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge. SETTING: EPIC II included 1265 intensive care units in 76 countries. PATIENTS: Patients in participating intensive care units on study day. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Of the 14,414 patients in EPIC II, 99 patients had Candida bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstream infections. Candida albicans (n = 70) was the predominant species. Primary therapy included monotherapy with fluconazole (n = 39), caspofungin (n = 16), and a polyene-based product (n = 12). Combination therapy was infrequently used (n = 10). Compared with patients with Gram-positive (n = 420) and Gram-negative (n = 264) bloodstream infections, patients with candidemia were more likely to have solid tumors (p < .05) and appeared to have been in an intensive care unit longer (14 days [range, 5-25 days], 8 days [range, 3-20 days], and 10 days [range, 2-23 days], respectively), but this difference was not statistically significant. Severity of illness and organ dysfunction scores were similar between groups. Patients with Candida bloodstream infections, compared with patients with Gram-positive and Gram-negative bloodstream infections, had the greatest crude intensive care unit mortality rates (42.6%, 25.3%, and 29.1%, respectively) and longer intensive care unit lengths of stay (median [interquartile range]) (33 days [18-44], 20 days [9-43], and 21 days [8-46], respectively); however, these differences were not statistically significant. CONCLUSION: Candidemia remains a significant problem in intensive care units patients. In the EPIC II population, Candida albicans was the most common organism and fluconazole remained the predominant antifungal agent used. Candida bloodstream infections are associated with high intensive care unit and hospital mortality rates and resource use

Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study

To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. DESIGN: A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge. SETTING: EPIC II included 1265 intensive care units in 76 countries. PATIENTS: Patients in participating intensive care units on study day. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Of the 14,414 patients in EPIC II, 99 patients had Candida bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstream infections. Candida albicans (n = 70) was the predominant species. Primary therapy included monotherapy with fluconazole (n = 39), caspofungin (n = 16), and a polyene-based product (n = 12). Combination therapy was infrequently used (n = 10). Compared with patients with Gram-positive (n = 420) and Gram-negative (n = 264) bloodstream infections, patients with candidemia were more likely to have solid tumors (p < .05) and appeared to have been in an intensive care unit longer (14 days [range, 5-25 days], 8 days [range, 3-20 days], and 10 days [range, 2-23 days], respectively), but this difference was not statistically significant. Severity of illness and organ dysfunction scores were similar between groups. Patients with Candida bloodstream infections, compared with patients with Gram-positive and Gram-negative bloodstream infections, had the greatest crude intensive care unit mortality rates (42.6%, 25.3%, and 29.1%, respectively) and longer intensive care unit lengths of stay (median [interquartile range]) (33 days [18-44], 20 days [9-43], and 21 days [8-46], respectively); however, these differences were not statistically significant. CONCLUSION: Candidemia remains a significant problem in intensive care units patients. In the EPIC II population, Candida albicans was the most common organism and fluconazole remained the predominant antifungal agent used. Candida bloodstream infections are associated with high intensive care unit and hospital mortality rates and resource use