631. Candidal Vs. Bacterial Severe Sepsis in the ICU: The Number-Needed-to-Treat (NNT)
Session: Abstracts: Mycology
Friday, October 22, 2010
Background:   Invasive Candida infections (ICI) continue to emerge in the ICU and elsewhere.  Despite the increasing availability of antifungals, the attributable mortality from ICI remains high. Culture-based antifungal treatment strategies result in delayed therapy. Therefore, empiric treatment strategies bare the potential to improve patient outcomes. While empiric broad-spectrum antibacterial coverage is the standard of care when treating septic patients, empiric anti-Candida therapy is rarely provided, even when the subject is a septic ICU patient at high risk for candidemia. The NNT for a particular organism reflect the number of patients that need to be treated empirically in order to cover one patient who’s infected by this organism.   We calculate the NNT in septic ICU patients with blood-stream infections and compare rates for specific bacteria vs Candida.

Methods:   Consecutive ICU patients with severe sepsis and positive blood cultures from a single tertiary-care hospital over a 7-year period were included. Patients with polymicrobial bacteremia were excluded. The NNT for specific species, as well as for groups of bacteria which require similar antibiotic therapy, were calculated.

Results:   A total of 1927 episodes of severe sepsis with positive blood-cultures were identified, of which 121 were polymicrobial. Of the 1806 that were included, 927 (51%), 704 (38%), and 175 (10%), were caused by Gram-positive bacteria, Gram-negative bacteria, and Candida (C. albicans 106, non albicans 69), respectively. The NNT for specific organisms and groups of organisms were: Staphylococcus aureus-5, enterobaricae-5, MRSA-9, Gram-negative non-fermenters -10, Candida-11, streptococci-12, Pseudomonas aeruginosa-17, Enterobacter spp-33, Streptococcus pneumonia-42, ESBL-producing Klebsiella-123.

Conclusion:   Candida is a substantial cause of severe sepsis in the ICU. Consequently, the NNT for Candida infections is relatively small and comparable to bacteria groups such as streptococci and Gram-negative non-fermenters, which are often covered empirically when treating ICU patients with severe sepsis. Given the high attributable mortality related to severe sepsis by Candida, it should be covered at least as frequently as bacteria with a similar NNT.

Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Yoav Golan, MD, MS , Box 041, Tufts Medical Center, Boston, MA
Scott Micek, Pharm, D , Barnes-Jewish Hospital, Saint Louis, MO
Marin Kollef, MD , Washington University School of Medicine, St. Louis, MO


Y. Golan, Yes
Merck, Pfizer, Astellas: Consultant, Grant Investigator and Speaker's Bureau, Consulting fee, Research grant and Speaker honorarium

S. Micek, None

M. Kollef, None

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