Invasive candidiasis in intensive care units in Tunisia: A prospective matched case-control study

Background: Invasive candidiasis (IC) is widely recognized as a major cause of morbidity and mortality especially among patients hospitalized in intensive care units (ICU). Hence, we conducted a prospective matched case-control study in three ICUs of the university hospital Sahloul in Sousse region (Tunisia), with the aim of describing the epidemiology, microbiology and risk factors of IC, in order to provide a risk predictive model for early diagnosis of these infections in ICU. Methods: A prospective matched case-control study was conducted jointly between the microbiology laboratory and three ICUs for a period of seven months (February-August 2020). A case report form was used to collect data prospectively for each included patient. Patient’s characteristics and risk factors were analyzed using univariate and multivariate conditional logistic regression models. Results: Out of 112 included patients, 30 patients had IC. The incidence rate of IC in ICU was 11.7 episodes per 1000 patient-days (86.4 per 1000 ICU admissions). Prolonged ICU stay (≥14 days) had a 3-fold increase in the risk of IC (p=0.003). Multivariate analysis showed that diabetes (p=0.035), cardiovascular disease (p=0.028) and recent surgery (p=0.004) were independent risk factors for IC. Non-albicans Candida species were responsible for 60% of IC cases and 70% of candidemia cases. Resistance to fluconazole was mainly seen among C. glabrata and uncommon Candida species. Conclusion: This study provides a risk predictive model for early diagnosis of IC in ICU, which can improve the diagnosis of these infections and contribute to guide targeted preventive and therapeutic antifungal strategies.