Postmortem Study and Attributable Mortality Due to Candidiasis in Non-Neutropenic Critical Patients

A prospective study was made in non-neutropenic ICU patients in whom Candida spp. has been detected, defining Invasive Candidiasis (IC) based on Dissemination and Multifocality, therapeutic protocol and the methodology of the postmortem study. Attributable mortality is distinguished according to statistical, histopathological and clinical criteria. The presence of Candida spp. was observed in 145 cases of 3389 ICU discharges (4.3%). There are 120/145 cases (83%) classified as IC and 25/145 colonization (17%). ICU mortality is 35% (51/145) and hospital mortality were 46% (67/145). The postmortem study has been carried out in 71% of those who died in the ICU (36/51). Candida albicans is the most frequently isolated species (87%), followed by Candida glabrata (18%). Isolation in bronchial secretions is the most frequent focus (86%), followed by digestive foci (pharynx 83% and gastric 78%). The attributable mortality has been 25% by statistical methods, 28% the postmortem study and 23% clinical data. Abdominal surgery and non-Candida albicans are risk factors for attributable mortality, and correct antifungal treatment is a protective factor. In conclusion, histopathological attributable mortality is like that defined by both statistics and clinical data, and the simplification of the definition of IC allows for faster and more targeted therapeutic action.