The risk of positive cultures for Candida in the critically ill patient.

It is frequently stated that a positive fungal culture is of little clinical significance unless the culture is obtained on repetitive blood specimens. We analyzed the mortality associated with a positive culture for Candida species in ICU patients from several locations over a 3-month period. Criteria for inclusion in this study were: (1) residence in the ICU for at least 4 days, (2) no GI tract alimentation during this period, and (3) administration of at least one antibiotic during this period. Forty-four patients fit these criteria; 23 had positive Candida cultures from at least one site and 12 (52%) died. Four of 21 patients (19%) who did not grow Candida died. Cultures of urine and sputum were most likely to be positive. Positive cultures from the urine, sputum, or wound were associated with at least a 50% mortality. This suggests that routine sputum and urine cultures may be of substantial clinical therapeutic and prognostic significance. Two patients had positive blood cultures and both died. No single class of antibiotics, surgical complications or underlying disease predisposed to these results. It is concluded that the presence of a single positive culture for Candida from any site in the critically ill surgical patient kept without GI alimentation and on any antibiotic is a grave prognostic sign which requires further attention.