Impact of COVID-19 and Earthquake Disaster on Candidemia in the ICU: Mortality and Treatment Outcomes

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Its epidemiology is influenced by evolving practices, resistance, and extraordinary circumstances such as pandemics and disasters. This study aimed to analyze candidemia epidemiology, risk factors, and outcomes, focusing on the impact of the COVID-19 pandemic and a major earthquake in southern Türkiye. Methods: We retrospectively analyzed 739 adult ICU patients diagnosed with candidemia between 2018 and 2023 at a tertiary referral center in Türkiye. Patients were grouped as pre-pandemic, COVID-19, and post-earthquake periods. Clinical characteristics, Candida species distribution, antifungal treatment timing, and mortality rates were compared. Logistic regression was performed to identify independent predictors of 30-day mortality. Results: The overall 30-day mortality rate was 68.5%. Mortality was significantly higher during the COVID-19 period (91.1%) compared to the pre-pandemic (57.6%) and post-earthquake (64.7%) periods (p48h) and failure to remove central venous catheters were associated with increased mortality. Multivariable analysis identified higher Charlson comorbidity index, Candida score, septic shock, mechanical ventilation, and delayed antifungal therapy as independent predictors of mortality (AUC=0.81). Conclusion: Candidemia in ICU patients is associated with high mortality, particularly under crisis conditions such as the COVID-19 pandemic and earthquake disaster. Early antifungal initiation and prompt catheter removal remain critical to improving outcomes. These findings highlight the need for strengthened infection control strategies and disaster preparedness in resource-challenged setting Candidemia Intensive Care Units Mortality Antifungal Agents COVID-19 Earthquakes Figures Figure 1 Introduction Candidemia, a serious bloodstream infection caused by Candida species, is a leading cause of morbidity and mortality in hospitalized patients, particularly those in intensive care units (ICUs) ( 1 , 2 ). The epidemiology of this infection is complex and dynamic, with reported changes in the prevalence of different Candida species and their susceptibility to antifungal agents ( 3 , 4 ). The risk factors for candidemia are multifactorial, including patient-related factors like age, comorbidities, and immune status, as well as healthcare-related factors such as prolonged ICU stay, surgical procedures, and the use of broad-spectrum antibiotics and invasive devices ( 5 , 6 ). In the literature, it has been reported that more than 50% of candidemia cases develop in ICU settings ( 7 ). According to US and European data, Candida species are responsible for 2–11% of nosocomial BSIs; this rate can increase to 8.3% in ICUs. Candidemia ranks as the fourth leading cause of nosocomial BSIs in the US and the fifth in Europe ( 8 ). The clinical course and outcome of candidemia can be particularly severe in critically ill patients, where the infection is often difficult to diagnose and can lead to septic shock and multi-organ failure ( 9 ). Early and effective antifungal therapy is crucial for improving patient outcomes, yet delays in diagnosis and treatment are common ( 10 ). The selection of an appropriate antifungal agent is further complicated by the global rise of non-albicans Candida species (NACs) and the emergence of antifungal resistance ( 11 , 12 ). Furthermore, recent global events have introduced new complexities to the epidemiology of healthcare-associated infections. The SARS-CoV-2 pandemic, for instance, led to an increase in ICU admissions, prolonged hospital stays, and widespread use of immunosuppressive therapies, all of which are known to predispose patients to opportunistic fungal infections ( 13 , 14 ). Similarly, natural disasters can disrupt healthcare systems, leading to patient transfers and changes in infection control practices, which may influence the incidence and pattern of nosocomial infections ( 15 , 16 ). Despite the growing body of literature on candidemia, the combined impact of public health crises and natural disasters on its epidemiology and patient outcomes remains under-investigated. This study, therefore, aims to analyze the epidemiological and clinical characteristics of candidemia in ICU patients over a five-year period in a tertiary hospital in southern Türkiye. We specifically sought to evaluate the impact of the SARS-CoV-2 pandemic and a major earthquake on the incidence, risk factors, species distribution, and mortality associated with candidemia. We hypothesize that these extraordinary circumstances would be associated with changes in candidemia patterns and increased mortality rates.. Methods The retrospective study included the files of adult cases diagnosed with candidemia in the ICU at the Mersin City Training and Research Hospital between January 1, 2018, and November 30, 2023. The data were obtained from the medical records database and included age, gender, the length of stay in the ICU, the site of infection, and history of surgery, hypertension, diabetes, cardiovascular diseases, nervous system diseases, digestive system diseases, respiratory system diseases, urinary system diseases, kidney diseases, and solid malignancies. Methods of nutrition and invasive interventions, including mechanical ventilation, central venous and arterial catheterization, were also noted. In addition, the complete blood count, C-reactive protein, procalcitonin, alanine transaminase, and creatinine results, and use of antibiotics and antifungals were recorded. Patients who died within the first 48 hours of hospitalization and files with missing data were excluded from the analysis. The files were further divided into groups based on whether they contained SARS-CoV-2 or earthquake-related injury diagnoses. Definitions The diagnosis of candidemia was established in cases where at least one positive blood culture was obtained, concomitant with symptoms and signs indicative of sepsis. Positive blood culture results recorded within 15 days from the date of diagnosis were considered part of the initial candidemia episode, and the remaining results were considered as separate episodes. An episode of candidemia was defined as nosocomial if it occurred within 72 hours following the initial admission. Additionally, it was classified as healthcare-associated if the patient had been hospitalized within the prior month or had undergone invasive procedures, such as dialysis, prior to the current admission. Neutropenia was defined as an absolute neutrophil count <500/mm³; hypoalbuminemia was defined as a serum albumin level <2.5 g/dL. The Candida score (CS) is a simple clinical scoring system used to predict the risk of candidemia in ICU patients. This score is based on criteria such as total parenteral nutrition, presence of surgical patients, multicolonization, and severe sepsis. A total score ≥3 is considered high risk for candidemia (9). Each patient's CS was calculated retrospectively based on file records. The Charlson Comorbidity Index (CCI) is a validated scoring system that predicts 10-year mortality risk by assigning weights ranging from 1 to 6 points based on the patient's accompanying chronic diseases. The CCI was calculated retrospectively for each patient based on relevant clinical data (10). Hypotension was defined as a systolic blood pressure <90 mmHg or a mean arterial pressure <65 mmHg. Mortality was defined as death from any cause occurring within 30 days following the growth of Candida spp. in culture. Early mortality was defined as deaths occurring within the first 48 hours after a diagnosis of candidemia. Microbiological analysis The microbiological analysis was executed in accordance with standard methodologies. Initially, culture samples were collected under aseptic conditions and subsequently placed into automated systems that rely on continuous monitoring, such as Bactec FX® or BacT/Alert®, where they were incubated for a maximum period of five days. Samples from bottles that exhibited a positive signal were then inoculated onto Sabouraud dextrose agar (SDA) and/or CHROMagar Candida® (CHROMagar Company, France) media after undergoing Gram staining. These samples were subsequently incubated at temperatures ranging from 35 to 37°C for a period of 24 to 48 hours. The resulting colonies were evaluated using both macroscopic and microscopic analysis. The VITEK® 2 Compact (bioMérieux, France) system was used to perform species-level identification. Conventional methods, including germ tube testing, were employed as necessary to validate the experimental results. Ethics The study was approved by the Toros University Scientific Research and Publication Ethics Committee on January 23, 2024, and was recorded under document number 16. The data has been anonymized, and the study was conducted in accordance with the principles of the Helsinki Declaration . Statistics Statistical analyses were performed using IBM SPSS Statistics version 22.0 (IBM Corp., Armonk, NY, USA) software. The distribution of continuous variables was assessed using the Kolmogorov–Smirnov test. The assessment of the non-normally distributed data for two groups was performed using the Mann–Whitney U test. The Kruskal–Wallis H test was employed to facilitate comparisons between more than two groups. For categorical variables, the Pearson chi-square test or Fisher's exact test was used as appropriate. The initial step in the analysis involved the examination of variables associated with mortality using univariate logistic regression analysis. Subsequently, significant variables were incorporated into the multivariate model. ROC (Receiver Operating Characteristic) analysis was applied to evaluate the predictive performance of the model, and classification accuracy was measured by the area under the curve (AUC) value. The significance level was set at p<0.05 for all analyses . Results The analysis included 739 candidemia cases. The initial diagnostic search revealed that there were no cases that included all three diagnoses of candidemia, SARS-CoV-2, and earthquake-related injury. As a result, three groups emerged: candidemia cases with SARS-CoV-2, candidemia cases with earthquake-related injuries, and candidemia-only patients. The demographic and clinical data analysis results of the subjects are presented in Table 1. The mean age of patients was 65.8 ± 17.95 years, and 51.96% (n = 384) were male. In terms of comorbidities, 72.3% of patients exhibited at least one chronic disease. The most prevalent comorbidities identified were diabetes mellitus (39.1%), malignancy (25.6%), and chronic renal failure (19.4%). The mean intensive care unit length of stay was calculated as 18.4 ± 11.2 days and was significantly different among groups (p<0.0015). A great number of cases required TPN (n=574, 77.67%), which also demonstrated a statistical difference when compared between groups (p<0.0027). The catheterization duration analysis revealed considerable differences between the groups, indicating that fewer cases in the candicemia-only group required catheterization (p<0.0037). Nevertheless, the majority of patients (n=673, 91.07%) underwent catheterization, and for 44.65% (n=330) of the patients, the procedure lasted between four and seven days. The mean CCI was 1.19±1.1. Despite the absence of statistical significance between the groups, a substantial discrepancy was observed in the mean values for the deceased and survivors (1.28±1.09, and 0.98±0.99, respectively, p=0.001). The mean Candida score of the Candidemia and SARS-CoV-2 cases group was considerably higher (2.3±1.07, p<0.0001). Besides, the comparison between the mean values for the deceased and survivors revealed a significant dissimilarity (2.36±1.02 and 1.28±1.24, respectively, p < 0.001). The most frequently identified species among all candidemia cases was Candida parapsilosis (n = 289, 39.1%), followed by Candida albicans (n = 216, 29.2%). The distribution of Candida species among groups showed a statistically significant difference (p<0.0001); while C. albicans was most common in candidemia-only cases, C. parapsilosis predominated in COVID-19 and earthquake-related cases. However, the comparison of 30-day mortality rates between species did not reveal statistical significance (p=0.511). Mortality was numerically higher in C. glabrata (79.1%) and C. tropicalis (72.1%) infections, while similar rates were observed in C. albicans (67.1%) and other rare species. The comparison of overall mortality between C. albicans (67.1%) and non-albicans Candida species (70.2%) also showed no significant difference (p=0.487). In the study, fluconazole emerged as the predominant antifungal agent across all groups (n=250, 33.83%), though notable variations in antifungal preference were observed. The highest proportion of patients not receiving antifungal therapy was observed in the candidemia and SARS-CoV-2 group (n=100, 32.79%). The 30-day mortalite rates based on antifungal treatment showed that in cases not receiving treatment, the rate was 83.2%, whereas the untreated cases resulted in 64.6% (p<0.0001). Furthermore, a statistically significant disparity in mortality was observed between cases where treatment was initiated after the third day and cases where antifungals were administered within 48 hours (76.1% and 58.9%, respectively; p<0.0001). The analysis including the biomarkers revealed that the earthquake-related injury group had the lowest mean procalcitonin (5.41±12.01, p=0.0021) and CRP levels (12.92±9.59, p=0.0018). Conversely, the highest mean platelet count was observed in this group (225020.81±154421.11, p=0.0064). Furthermore, an analysis based on mortality revealed a marked increase in white blood cell counts in deceased patients compared to survivors. The median white blood cell count in deceased patients was significantly higher at 11,310/mm³ (100–266,620), while the median count in survivors was 9,850/mm³ (130–76,610) (p = 0.007). Comparably, platelet counts were elevated in surviving patients (median: 227,000/mm³) and notably diminished in the mortality group (median: 130,500/mm³) (p < 0.001). Furthermore, creatinine, procalcitonin, and CRP levels were significantly elevated in the deceased cohort compared to the surviving (p<0.001 for all) (Table 2). Multivariate logistic regression analysis of independent risk factors associated with 30-day mortality demonstrated that the absence of antifungal therapy was independently associated with a threefold increase in mortality risk (OR: 2.91; 95% CI: 1.58–5.36; p<0.001). Each mg/dL increase in serum creatinine was linked to higher mortality (OR: 1.23; 95% CI: 1.07–1.41; p<0.001). The mortality risk increased by 28% for each unit increase in the Charlson Comorbidity Index (CCI) when analyzed as a continuous variable (OR: 1.28; 95% CI: 1.12–1.46; p=0.001). Similarly, the categorical model showed a 34% increase per unit (OR: 1.34; 95% CI: 1.12–1.59; p=0.001). Higher Candida scores (OR: 2.26; 95% CI: 1.91–2.68; p<0.001), intubation (OR: 1.53; p=0.027), the presence of shock (OR: 1.66; p=0.011), and TPN use (OR: 3.49; 95% CI: 2.30–5.29; p<0.001) were also independently associated with mortality. The model’s AUC was 0.81 (95% CI: 0.77–0.85), indicating good, discrimination (Figure 1). The comparative analysis of the 30-day mortality rates between the groups showed that the mortality rate of the candidemia-only cases (67.8%) was significantly lower than the remaining (p=0.024). However, despite the high mortality rate observed among earthquake-injury group cases (%84.7%), no statistical significance has been identified (p=0.775). Discussion This study, utilizinga comparative approach, analyzed candidemia attacks in patients with SARS-CoV-2, earthquake-related injuries, and candidemia-only cases. The objective was to analyze the impact of changes in various parameters, including laboratory tests, invasive interventions, organ function-related conditions, antifungal strategies, and pathogen diversity, on survival. Initially, it is evident that the elevated mean age and the presence of multiple comorbidities in the majority of cases underline the significance of host characteristics in candidemia. It is imperative to acknowledge that the course can be expected to progress more rapidly, particularly when additional conditions arise. The present findings are consistent with the literature indicating that advanced age and a high comorbidity burden are significant factors in the development of candidemia in individuals ( 13 , 14 ). The multivariate logistic regression analysis that included Candida score, catheter duration, intubation, presence of shock, and TPN use, the Candida score was found to be an independent predictor of mortality, suggesting that the Candida score may be useful in identifying high-risk patients with a threshold value of ≥ 3 and may be particularly beneficial in early diagnosis similarly to the findings of León et al. and other studies’ findings ( 9 , 15 ). Nevertheless, research findings emphasize that the negative predictive value of this score may be limited in ICU patients and that it must be supported by colony density (e.g. fungal load on the catheter surface) or biomarkers such as 1,3-β-D-glucan ( 16 ). Catheter duration and the presence of intubation were notably associated with mortality and are consistent with previously reported cohort analyzes ( 5 , 17 ). Particularly, prolonged catheterization may contribute to the development of invasive infections by increasing Candida colonization. Intubation, on the other hand, increases the risk of secondary infections associated with mechanical ventilation ( 1 , 18 , 19 ). Furthermore, shock and the use of TPN have been identified as significant determinants of mortality. The presence of shock is indicative of hemodynamicinstability and organ failure, while TPN has been shown to facilitate fungal translocation by disrupting gastrointestinal mucosal integrity and accelerate the development of infection ( 20 , 21 ). Moreover, it was shown that the risk of mortality was approximately three times higher in cases not receiving antifungal treatment (OR: 2.91; 95% CI: 1.58–5.36), that each point increase in the CCI score increased the risk of mortality by 28% (OR: 1.28; 95% CI: 1.12–1.46), and that each mg/dL increase in creatinine level is associated with a significant increase in the risk of death (OR: 1.23; 95% CI: 1.07–1.41). Although the area under the ROC curve (AUC) value of our model was calculated as 0.81, indicating that the model's performance in predicting mortality is at a good level, the interpretation of these results must be approached with a degree of caution, as they may also be attributable to the general condition of the patients and the severity of their critical illness ( 22 , 23 ). The three times higher risk for mortality finding for cases who have not received antifungal treatment highlights the necessity of the specific treatment. In this study, the mortality risk in cases where antifungal treatment was not initiated was found to be approximately three times higher. Notwithstanding the initiation of treatment, the preservation of life can become significantly more challenging, even in patients who receive antifungal treatment more than 48 hours after the onset of symptoms ( 24 , 25 ). Furthermore, an increase in the CCI (Charlson Comorbidity Index) score by one point was observed to result in a 28% increase in the risk of mortality (OR: 1.28; 95% CI: 1.12–1.46), thereby demonstrating that the comorbidity burden is a critical determinant in the course of candidemia. As indicated by earlier research findings, an elevated CCI score has been demonstrated to serve as an independent predictor of mortality risk in patients diagnosed with candidemia ( 26 , 27 ). In accordance with the results of a large-scale surveillance study, the present study identified a significant association between elevated creatinine levels and an increased mortality risk, with a 1 mg/dL increase in creatinine levels resulting in an odds ratio of 1.23 (95% confidence interval: 1.07–1.41), suggesting that renal dysfunction has a significant impact on prognosis ( 28 ). The Area Under the ROC Curve (AUC) value of 0.81, which indicates the good performance of our multivariate model in predicting mortality, is similar to the findings of prognostic models previously developed in different ICU cohorts ( 9 , 19 ). However, the results of our model may also reflect the general critical condition of the patients and the additional risks they are exposed to in the intensive care unit; therefore, they should be interpreted with caution. Our findings show that the initiation of early antifungal treatment, comorbidity assessment, and close monitoring of organ functions are critical elements in predicting mortality, but the robustness of our model needs to be reinforced with external validation studies conducted in different centers. In terms of the distribution of Candida species, non-albicans Candida (NAC) species were found to be predominant, with species such as C. parapsilosis being particularly prominent. This distribution is consistent with global trends, and the virulence traits of NAC species, such as azole resistance and biofilm formation, may contribute to differences in treatment response ( 2 , 29 ). The delayed initiation of antifungal treatment, or the failure to initiate treatment, has been identified as a significant risk factor for mortality. A delay of more than two days between obtaining a positive culture sample and initiating treatment was found to be significantly associated with mortality, as has been previously reported in the literature ( 30 ). Laboratory parameters such as elevated creatinine, increased procalcitonin, and thrombocytopenia, which can be considered early indicators of clinical deterioration by reflecting the severity of sepsis and organ dysfunction, have been found to be associated with mortality, as in the results of other studies ( 31 ). A growing body of literature has emerged on the subject of co-occurring cases of SARS-CoV-2 and candidemia, referred as Covid-19 associated candidemia (CAC), indicating a marked increase in candidemia rates, particularly among ICU patients. A recent series of systematic reviews have reported a CAC prevalence of around 4.3%, emphasising that mortality occurred in approximately 68% of these cases ( 32 ). This phenomenon is hypothesised to be attributable to the immunosuppressive effect of SARS-CoV-2, in conjunction with the concomitant administration of steroids and tocilizumab. As demonstrated in this study, which evaluates the impact of extraordinary circumstances, such as disasters and pandemics, on the incidence and mortality of candidemia, the mortality rate is notably higher in cases of candidemia accompanied by SARS-CoV-2, which is in parallel to the existing literature on the subject ( 33 , 34 ). The increase in candidemia observed in the post-earthquake period is a topic that has received limited attention in the literature. Nevertheless, the literature has reported the increase in the incidence of fungal infections in the aftermath of natural disasters. Traumatic injuries, the increased need for intensive care, disruptions in healthcare infrastructure, and contaminated environmental conditions are shown as the main reasons for this rise in incidence rates, especially in the case of major earthquakes. Research undertaken following the Wenchuan earthquake revealed the presence of various fungal pathogens, including Candida species, in wound and blood cultures ( 35 ). In a similar manner, the 2008 Sichuan earthquake saw the identification of numerous fungal agents, chiefly Candida tropicalis . Furthermore, an escalation in mucormycosis and aspergillosis cases was documented in the aftermath of disasters such as tsunamis and tornadoes ( 36 ). Research conducted in Türkiye following the 2023 earthquake also detected a substantial surge in fungal infection rates, particularly among trauma patients admitted to intensive care units ( 37 ). This study revealed a substantial increase in C. parapsilosis isolates following the earthquake, indicating a potential association between this species and the transmission via hospital equipment and healthcare workers' hands as proposed in other studies ( 38 ). In general, these findings suggest that the distribution of candidemia in earthquake-related cases in our study is consistent with those observed in studies conducted on invasive fungal infections in disaster conditions. Our findings underscores the significance of maintaining infection control practices during disaster situations, thereby reinforcing the importance of infection prevention strategies in healthcare settings. The study is subject to certain limitations. Primarily, due to the retrospective nature of the investigation, it was not possible to access all the clinical data; consequently, antifungal susceptibility test results could not be provided for the entire study group. Furthermore, the identification of species was not performed using molecular methods, but rather conventional methods, which has been demonstrated to increase the margin of error, particularly in the diagnosis of rare species and important pathogens such as C. auris ( 39 , 40 ). Moreover, the incorporation of advanced biomarker analyses, which have the potential to yield more reliable results with respect to negative predictive value, was not feasible within the scope of this study. Conclusion This study presents a sound analysis that highlights the role of the Candida score in predicting mortality, in addition to known risk factors such as advanced age, high comorbidity score, intubation, catheter duration, presence of shock, and TPN use. The research also demonstrates changes in candidemia patterns during the SARS-CoV-2 pandemic and a major seismic event, and provides statistical support for the effect of antifungal treatment timing on mortality. The analysis reveals a correlation between the predominance of non-Candida albicans species and the emergence of antifungal resistance and treatment failure. It is hypothesised that the multivariate model with good predictive powerpresented in this study will contribute to the evaluation of empirical antifungal treatment decisions in high-risk intensive care patients in conjunction with clinical, microbiological, and epidemiological data. Abbreviations ALT : Alanine aminotransferase APC : Article Processing Charge AUC : Area under the curve CCI : Charlson Comorbidity Index CRP : C-reactive protein CS : Candida score CVP : Central venous pressure ICU : Intensive care unit NAC : Non-albicans Candida ROC : Receiver operating characteristic SARS-CoV-2 : Severe Acute Respiratory Syndrome Coronavirus-2 SD : Standard deviation SPSS : Statistical Package for the Social Sciences TPN : Total parenteral nutrition WBC : White blood cell Declarations Ethics approval and consent to participate: Approved by the Toros University Scientific Research and Publication Ethics Committee (No:16, 23 January 2024), in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding No funding was received for this study. Availability of data and materials The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. Authors' contributions MU conceived and designed the study. MU and BÇD performed data collection and statistical analysis. MU interpreted the data. MU and BÇD drafted the manuscript. All authors read and approved the final version. Clinical trial registration Not applicable. Author details 1.Department of Infectious Diseases and Clinical Microbiology, Mersin City Training and Research Hospital, Mersin, Türkiye References Arendrup MC, Patterson TF. Multidrug-resistant Candida: epidemiology, molecular mechanisms, and treatment. J Infect Dis. 2017;216(Suppl_3):S445–51. Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62(4):e1–50. Bassetti M, et al. 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Clinical and microbiological features of Candida bloodstream infections in Turkish intensive care units: a prospective multicenter study. Mycoses. 2020;63(7):721–9. Machado M, Valerio M, Álvarez-Uría A, et al. Invasive fungal infections during COVID-19: a retrospective study in a tertiary-care hospital. J Fungi (Basel). 2021;7(4):291. Reizine F, Massart N, Mansour A, Fedun Y, Machut A, Vacheron CH, Savey A, Friggeri A, Lepape A; REAREZO study group. Relationship between SARS-CoV-2 infection and ICU-acquired candidemia in critically ill medical patients: a multicenter prospective cohort study. Crit Care. 2024;28(1):320. doi:10.1186/s13054-024-05104-w. Baten N, Wajed S, Talukder A, Masum MHU, Rahman MM. Coinfection of fungi with SARS-CoV-2 is a detrimental health risk for COVID-19 patients. Beni Suef Univ J Basic Appl Sci. 2022;11(1):64. doi:10.1186/s43088-022-00245-9. Wang S, Li Y, Chi C, Guo L, Wang H, Zhang C, et al. Clinical analysis of infections after Wenchuan earthquake: fungal pathogens in wound and blood cultures. Chin J Traumatol. 2010;13(5):275-9. PMID:20880446; PMCID:PMC3086233. Seidel D, et al. Impact of climate change and natural disasters on fungal infections. Lancet Microbe. 2024;5(2):e84-e94. doi:10.1016/S2666-5247(24)00039-9. Avcu G, et al. Infections after the earthquake disaster. J Pediatr Res. 2023;10.4274/jpr.galenos.2023.56767. Mesini A, Principe L, Massimo D, et al. Candida parapsilosis bloodstream infections in neonatal and pediatric intensive care units: epidemiology and prevention. J Fungi (Basel). 2021;7(6):470. Chen H, Zhou X, Ren B, Cheng L. The regulation of hyphae growth in Candida albicans. Virulence. 2020;11(1):337–48. Tables Table 1. Initial analysis results of the demographic and clinical data Groups Candidemia & SARS-CoV-2 Candidemia & Earthquake-related injury Candidemia only Variable Rates p n=305 % n=173 % n=261 % n=739 % Gender Female 150 42.25 79 22.25 126 35.49 355 48.04 0.76 Male 155 40.36 94 24.47 135 35.15 384 51.96 Intubated No 152 38.19 91 22.86 155 38.94 398 53.86 0.07 Yes 153 44.87 82 24.05 106 31.09 341 46.14 TPN No 49 29.7 45 27.27 71 43.03 165 22.33 0.003 Yes 256 44.6 128 22.3 190 33.1 574 77.67 CVP No 18 27.27 19 28.79 29 43.94 66 8.93 0.053 Yes 287 42.64 154 22.88 232 34.47 673 91.07 Catheterization period (days) 1-3 49 33.11 36 24.32 63 42.57 148 20.03 0.004 4-7 137 41.52 81 24.55 112 33.94 330 44.65 7< 101 51.79 37 18.97 57 29.23 195 26.39 Not catheterized 18 27.27 19 28.79 29 43.94 66 8.93 Shock No 170 38.46 111 25.11 161 36.43 442 59.81 0.146 Yes 135 45.45 62 20.88 100 33.67 297 40.19 Dialysis No 261 40.91 153 23.98 224 35.11 638 86.33 0.652 Yes 44 43.56 20 19.8 37 36.63 101 13.67 Burns No 293 41.44 166 23.48 248 35.08 707 95.67 0.812 Yes 12 37.5 7 21.88 13 40.63 32 4.33 Surgical intervention No 248 39.43 139 22.1 242 38.47 629 85.12 0.0001 Yes 57 51.82 34 30.91 19 17.27 110 14.88 Kidney Failure No 257 39.91 155 24.07 232 36.02 644 87.14 0.142 Yes 48 50.53 18 18.95 29 30.53 95 12.86 Malignant neoplasm No 239 41.86 135 23.64 197 34.5 571 77.27 0.691 Yes 66 39.29 38 22.62 64 38.1 168 22.73 Corticosteroid need No 291 43.89 140 21.12 232 34.99 663 89.72 <0.0001 Yes 14 18.42 33 43.42 29 38.16 76 10.28 Antifungal treatment None 100 54.05 32 17.3 53 28.65 185 25.03 0.0006 Anidulafungin 82 37.96 47 21.76 87 40.28 216 29.23 Caspofungin 20 26.32 28 36.84 28 36.84 76 10.28 Voriconazole/Amphotericin B 4 33.33 5 41.67 3 25 12 1.62 Fluconazole 99 39.6 61 24.4 90 36 250 33.83 *Candida Species Candida albicans 58 26.85 35 16.2 123 56.94 216 29.23 <0.0001 Candida glabrata 21 48.84 15 34.88 7 16.28 43 5.82 Candida parapsilosis 129 44.64 72 24.91 88 30.45 289 39.11 Candida tropicalis 84 50.91 40 24.24 41 24.85 165 22.33 Other Candida spp 13 50 11 42.31 2 7.69 26 3.52 Albicans Albicans 58 26.85 35 16.2 123 56.94 216 29.23 <0.0001 Non-Albicans 247 47.23 138 26.39 138 26.39 523 70.77 Mortality (30 days Deceased 239 47.9 110 22.04 150 30.06 499 67.52 <0.0001 Alive 66 27.5 63 26.25 111 46.25 240 32.48 C. albicans-related mortality Deceased 58 100 25 71.43 62 50.41 145 67.13 <0.0001 Total 58 35 123 216 Non-Albicans related mortality Deceased 196 79.35 71 51.45 88 63.77 355 67.88 <0.0001 Total 247 138 138 523 Mean±SD Mean±SD Mean±SD Mean±SD Age 67.44±18.24 65.86±17.49 63.84±17.78 65.8±17.95 0.038 Albumin 2.79±0.53 2.82±0.54 2.86±0.58 2.82±0.55 0.423 ALT 52.81±149.19 38.75±96.91 43.26±85.48 46.14±118.18 0.640 Creatinin 1.55±1.29 1.31±1.19 1.4±1.22 1.44±1.24 0.105 WBC 13709.12±10371.05 13378.18±10824.7 12031.64±9354.36 13039.2±10149.6 0.060 Neutrophils 7750.52±7493.36 8656.09±9923.37 7732.36±9950.94 7956.1±9006.43 0.376 Lymphocytes 4354.51±7549.41 3592.18±5756.02 3763.43±5697 3967.29±6537.79 0.836 Platelets 187091.48±153273.16 225020.81±154421.11 211674.33±155513.93 204652.91±154910.37 0.006 Procalcitonin 8.6±16.89 5.41±12.01 8.19±17.65 7.71±16.2 0.002 CRP 15.64±9.5 12.92±9.59 14.08±9.72 14.45±9.65 0.002 Duration of hospitalization 22.82±13.04 21.58±11.35 21.1±12.52 21.92±12.49 0.243 CCI score 1.19±1.13 1.1±1.05 1.25±1.09 1.19±1.1 0.355 Candida Score 2.3±1.07 1.86±1.24 1.82±1.26 2.03±1.2 <p<0.001 *The other Candida species group includes the following species: Candida auris, Candida ciferrii, Candida dubliniensis, Candida guilliermondii, Candida kefyr, Candida krusei, and Candida lusitaniae. Table 2. Laboratory parameters of ICU patients with candidemia according to 30-day mortality status (n=739) Variables Overall Median (Min–Max) Survivors Median (Min–Max) Non-survivors Median (Min–Max) p * Leukocyte (×10³/µL) 10560.0 (100–78490) 9140.0 (130–76610) 11360.0 (100–78490) <0.001 Neutrophil (×10³/µL) 5330.0 (3.85–79990.0) 4320.0 (4.31–59770.0) 5695.0 (3.85–79990.0) 0.068 Lymphocyte (×10³/µL) 1510.0 (10–55920) 1920.0 (90–53570) 1360.0 (10–55920) 0.011 Platelet (×10³/µL) 171000.0 (6000–1240000) 247000.0 (8000–990000) 152500.0 (6000–1240000) <0.001 ALT (U/L) 20.0 (7–2158) 21.0 (7–892) 19.0 (7–2158) 0.643 Creatinine (mg/dL) 0.98 (0.1–6.29) 0.71 (0.1–4.95) 1.1 (0.11–6.29) <0.001 Procalcitonin (ng/mL) 1.38 (0.01–75.0) 0.58 (0.01–75.0) 2.05 (0.01–75.0) <0.001 CRP (mg/L) 13.9 (0.11–71.0) 9.27 (0.11–71.0) 15.4 (0.16–51.7) <0.001 * Mann-Whitney U Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 25 Apr, 2026 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 13 Mar, 2026 Reviews received at journal 12 Mar, 2026 Reviewers agreed at journal 11 Mar, 2026 Reviewers agreed at journal 21 Dec, 2025 Reviews received at journal 18 Dec, 2025 Reviewers agreed at journal 09 Dec, 2025 Reviewers invited by journal 21 Sep, 2025 Editor invited by journal 18 Sep, 2025 Editor assigned by journal 16 Sep, 2025 Submission checks completed at journal 16 Sep, 2025 First submitted to journal 14 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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UĞUZ","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYDCCAxCKH0JVADEzcwMRWhIYJCHKzoC0MJKihbENTOLXwnf7dJrkzx92Evwz0q9J/pxXG83fDtTyo2IbTi2S53K3SfMkJEtI3Mgpk5Dcdjx3xmHGBsaeM7dxajE4w7tNmiGBuY7hRk6ahOG2Y7kNQC3MjG34tUj+SKiXkAdpSZxzLHc+MVokeBIOSxjcSD8mcbChJncDIS2SZ3g3W/OkHZcwPPOG2bLh2IHcjUAtB/H5he8M78abP2yqJeSOpz+8+aOmLnfe+cMHH/yowK0FCfAYAInDYOYBYtQDAfsDIFFHpOJRMApGwSgYSQAAcS9eIXjoNfQAAAAASUVORK5CYII=","orcid":"","institution":"Mersin City Training and Research Hospital","correspondingAuthor":true,"prefix":"","firstName":"Mustafa","middleName":"","lastName":"UĞUZ","suffix":""},{"id":523534927,"identity":"eed67210-515e-484f-afd9-3f1c40ef60d6","order_by":1,"name":"Berfin ÇİRKİN DORUK","email":"","orcid":"","institution":"Mersin City Training and Research 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16:18:54","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":203217,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7612495/v1/cc2b3c158b6cf127e2f29852.html"},{"id":92733156,"identity":"5f238a61-6d99-441a-b886-ab128dc2b6b6","added_by":"auto","created_at":"2025-10-03 16:18:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":119515,"visible":true,"origin":"","legend":"\u003cp\u003eReceiver operating characteristic (ROC) curve for 30-day mortality prediction. The multivariate model achieved an AUC of 0.81 (95% CI: 0.77–0.85). The optimal cut-off value determined by the Youden index was 0.30, which yielded a sensitivity of 84.1% and a specificity of 84.6%.\u003c/p\u003e","description":"","filename":"Figure1ROCBMJ.png","url":"https://assets-eu.researchsquare.com/files/rs-7612495/v1/a1569222f5061e8a57fcdac1.png"},{"id":107927775,"identity":"3762eabc-4bbc-4404-bf95-44e67ecdc69a","added_by":"auto","created_at":"2026-04-27 16:04:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":652755,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7612495/v1/f97f5efa-e79d-4842-8e59-7ae45e809966.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eImpact of COVID-19 and Earthquake Disaster on Candidemia in the ICU: Mortality and Treatment Outcomes\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCandidemia, a serious bloodstream infection caused by Candida species, is a leading cause of morbidity and mortality in hospitalized patients, particularly those in intensive care units (ICUs) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The epidemiology of this infection is complex and dynamic, with reported changes in the prevalence of different Candida species and their susceptibility to antifungal agents (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The risk factors for candidemia are multifactorial, including patient-related factors like age, comorbidities, and immune status, as well as healthcare-related factors such as prolonged ICU stay, surgical procedures, and the use of broad-spectrum antibiotics and invasive devices (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In the literature, it has been reported that more than 50% of candidemia cases develop in ICU settings (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). According to US and European data, Candida species are responsible for 2\u0026ndash;11% of nosocomial BSIs; this rate can increase to 8.3% in ICUs. Candidemia ranks as the fourth leading cause of nosocomial BSIs in the US and the fifth in Europe (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The clinical course and outcome of candidemia can be particularly severe in critically ill patients, where the infection is often difficult to diagnose and can lead to septic shock and multi-organ failure (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Early and effective antifungal therapy is crucial for improving patient outcomes, yet delays in diagnosis and treatment are common (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The selection of an appropriate antifungal agent is further complicated by the global rise of non-albicans Candida species (NACs) and the emergence of antifungal resistance (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFurthermore, recent global events have introduced new complexities to the epidemiology of healthcare-associated infections. The SARS-CoV-2 pandemic, for instance, led to an increase in ICU admissions, prolonged hospital stays, and widespread use of immunosuppressive therapies, all of which are known to predispose patients to opportunistic fungal infections (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Similarly, natural disasters can disrupt healthcare systems, leading to patient transfers and changes in infection control practices, which may influence the incidence and pattern of nosocomial infections (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite the growing body of literature on candidemia, the combined impact of public health crises and natural disasters on its epidemiology and patient outcomes remains under-investigated. This study, therefore, aims to analyze the epidemiological and clinical characteristics of candidemia in ICU patients over a five-year period in a tertiary hospital in southern T\u0026uuml;rkiye. We specifically sought to evaluate the impact of the SARS-CoV-2 pandemic and a major earthquake on the incidence, risk factors, species distribution, and mortality associated with candidemia. We hypothesize that these extraordinary circumstances would be associated with changes in candidemia patterns and increased mortality rates..\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe retrospective study included the files of adult cases diagnosed with candidemia in the ICU at the Mersin City Training and Research Hospital between January 1, 2018, and November 30, 2023. The data were obtained from the medical records database and included age, gender, the length of stay in the ICU, the site of infection, and history of surgery, hypertension, diabetes, cardiovascular diseases, nervous system diseases, digestive system diseases, respiratory system diseases, urinary system diseases, kidney diseases, and solid malignancies. Methods of nutrition and invasive interventions, including mechanical ventilation, central venous and arterial catheterization, were also noted. In addition, the complete blood count, C-reactive protein, procalcitonin, alanine transaminase, and creatinine results, and use of antibiotics and antifungals were recorded. Patients who died within the first 48 hours of hospitalization and files with missing data were excluded from the analysis.\u003c/p\u003e\n\u003cp\u003eThe files were further divided into groups based on whether they contained SARS-CoV-2 or earthquake-related injury diagnoses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDefinitions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe diagnosis of candidemia was established in cases where at least one positive blood culture was obtained, concomitant with symptoms and signs indicative of sepsis. Positive blood culture results recorded within 15 days from the date of diagnosis were considered part of the initial candidemia episode, and the remaining results were considered as separate episodes. An episode of candidemia was defined as nosocomial if it occurred within 72 hours following the initial admission. Additionally, it was classified as healthcare-associated if the patient had been hospitalized within the prior month or had undergone invasive procedures, such as dialysis, prior to the current admission. Neutropenia was defined as an absolute neutrophil count \u0026lt;500/mm\u0026sup3;; hypoalbuminemia was defined as a serum albumin level \u0026lt;2.5 g/dL. The Candida score (CS) is a simple clinical scoring system used to predict the risk of candidemia in ICU patients. This score is based on criteria such as total parenteral nutrition, presence of surgical patients, multicolonization, and severe sepsis. A total score \u0026ge;3 is considered high risk for candidemia (9). Each patient\u0026apos;s CS was calculated retrospectively based on file records. The Charlson Comorbidity Index (CCI) is a validated scoring system that predicts 10-year mortality risk by assigning weights ranging from 1 to 6 points based on the patient\u0026apos;s accompanying chronic diseases. The CCI was calculated retrospectively for each patient based on relevant clinical data (10).\u003c/p\u003e\n\u003cp\u003eHypotension was defined as a systolic blood pressure \u0026lt;90 mmHg or a mean arterial pressure \u0026lt;65 mmHg. Mortality was defined as death from any cause occurring within 30 days following the growth of Candida spp. in culture. Early mortality was defined as deaths occurring within the first 48 hours after a diagnosis of candidemia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMicrobiological analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe microbiological analysis was executed in accordance with standard methodologies. Initially, culture samples were collected under aseptic conditions and subsequently placed into automated systems that rely on continuous monitoring, such as Bactec FX\u0026reg; or BacT/Alert\u0026reg;, where they were incubated for a maximum period of five days. Samples from bottles that exhibited a positive signal were then inoculated onto Sabouraud dextrose agar (SDA) and/or CHROMagar Candida\u0026reg; (CHROMagar Company, France) media after undergoing Gram staining. These samples were subsequently incubated at temperatures ranging from 35 to 37\u0026deg;C for a period of 24 to 48 hours. The resulting colonies were evaluated using both macroscopic and microscopic analysis. The VITEK\u0026reg; 2 Compact (bioM\u0026eacute;rieux, France) system was used to perform species-level identification. Conventional methods, including germ tube testing, were employed as necessary to validate the experimental results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Toros University Scientific Research and Publication Ethics Committee on January 23, 2024, and was recorded under document number 16. The data has been anonymized, and the study was conducted in accordance with the principles of the Helsinki Declaration\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analyses were performed using IBM SPSS Statistics version 22.0 (IBM Corp., Armonk, NY, USA) software. The distribution of continuous variables was assessed using the Kolmogorov\u0026ndash;Smirnov test. The assessment of the non-normally distributed data for two groups was performed using the Mann\u0026ndash;Whitney U test. The Kruskal\u0026ndash;Wallis H test was employed to facilitate comparisons between more than two groups. For categorical variables, the Pearson chi-square test or Fisher\u0026apos;s exact test was used as appropriate. The initial step in the analysis involved the examination of variables associated with mortality using univariate logistic regression analysis. Subsequently, significant variables were incorporated into the multivariate model. ROC (Receiver Operating Characteristic) analysis was applied to evaluate the predictive performance of the model, and classification accuracy was measured by the area under the curve (AUC) value. The significance level was set at p\u0026lt;0.05 for all analyses\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe analysis included 739 candidemia cases. The initial diagnostic search revealed that there were no cases that included all three diagnoses of candidemia, SARS-CoV-2, and earthquake-related injury. As a result, three groups emerged: candidemia cases with SARS-CoV-2, candidemia cases with earthquake-related injuries, and candidemia-only patients. The demographic and clinical data analysis results of the subjects are presented in Table 1.\u003c/p\u003e\n\u003cp\u003eThe mean age of patients was 65.8 \u0026plusmn; 17.95 years, and 51.96% (n = 384) were male. In terms of comorbidities, 72.3% of patients exhibited at least one chronic disease. The most prevalent comorbidities identified were diabetes mellitus (39.1%), malignancy (25.6%), and chronic renal failure (19.4%). The mean intensive care unit length of stay was calculated as 18.4 \u0026plusmn; 11.2 days and was significantly different among groups (p\u0026lt;0.0015). A great number of cases required TPN (n=574, 77.67%), which also demonstrated a statistical difference when compared between groups (p\u0026lt;0.0027). The catheterization duration analysis revealed considerable differences between the groups, indicating that fewer cases in the candicemia-only group required catheterization (p\u0026lt;0.0037). Nevertheless, the majority of patients (n=673, 91.07%) underwent catheterization, and for 44.65% (n=330) of the patients, the procedure lasted between four and seven days. The mean CCI was 1.19\u0026plusmn;1.1. Despite the absence of statistical significance between the groups, a substantial discrepancy was observed in the mean values for the deceased and survivors (1.28\u0026plusmn;1.09, and 0.98\u0026plusmn;0.99, respectively, p=0.001). The mean Candida score of the Candidemia and SARS-CoV-2 cases group was considerably higher (2.3\u0026plusmn;1.07, p\u0026lt;0.0001). Besides, the comparison between the mean values for the deceased and survivors revealed a significant dissimilarity (2.36\u0026plusmn;1.02 and 1.28\u0026plusmn;1.24, respectively, p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003eThe most frequently identified species among all candidemia cases was Candida parapsilosis (n = 289, 39.1%), followed by Candida albicans (n = 216, 29.2%). The distribution of Candida species among groups showed a statistically significant difference (p\u0026lt;0.0001); while C. albicans was most common in candidemia-only cases, C. parapsilosis predominated in COVID-19 and earthquake-related cases. However, the comparison of 30-day mortality rates between species did not reveal statistical significance (p=0.511). Mortality was numerically higher in C. glabrata (79.1%) and C. tropicalis (72.1%) infections, while similar rates were observed in C. albicans (67.1%) and other rare species. The comparison of overall mortality between C. albicans (67.1%) and non-albicans Candida species (70.2%) also showed no significant difference (p=0.487).\u003c/p\u003e\n\u003cp\u003eIn the study, fluconazole emerged as the predominant antifungal agent across all groups (n=250, 33.83%), though notable variations in antifungal preference were observed. The highest proportion of patients not receiving antifungal therapy was observed in the candidemia and SARS-CoV-2 group (n=100, 32.79%). The 30-day mortalite rates based on antifungal treatment showed that in cases not receiving treatment, the rate was 83.2%, whereas the untreated cases resulted in 64.6% (p\u0026lt;0.0001). Furthermore, a statistically significant disparity in mortality was observed between cases where treatment was initiated after the third day and cases where antifungals were administered within 48 hours (76.1% and 58.9%, respectively; p\u0026lt;0.0001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe analysis including the biomarkers revealed that the earthquake-related injury group had the lowest mean procalcitonin (5.41\u0026plusmn;12.01, p=0.0021) and CRP levels (12.92\u0026plusmn;9.59, p=0.0018). Conversely, the highest mean platelet count was observed in this group (225020.81\u0026plusmn;154421.11, p=0.0064). Furthermore, an analysis based on mortality revealed a marked increase in white blood cell counts in deceased patients compared to survivors. The median white blood cell count in deceased patients was significantly higher at 11,310/mm\u0026sup3; (100\u0026ndash;266,620), while the median count in survivors was 9,850/mm\u0026sup3; (130\u0026ndash;76,610) (p = 0.007). Comparably, platelet counts were elevated in surviving patients (median: 227,000/mm\u0026sup3;) and notably diminished in the mortality group (median: 130,500/mm\u0026sup3;) (p \u0026lt; 0.001). Furthermore, creatinine, procalcitonin, and CRP levels were significantly elevated in the deceased cohort compared to the surviving (p\u0026lt;0.001 for all) (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMultivariate logistic regression analysis of independent risk factors associated with 30-day mortality demonstrated that the absence of antifungal therapy was independently associated with a threefold increase in mortality risk (OR: 2.91; 95% CI: 1.58\u0026ndash;5.36; p\u0026lt;0.001). Each mg/dL increase in serum creatinine was linked to higher mortality (OR: 1.23; 95% CI: 1.07\u0026ndash;1.41; p\u0026lt;0.001). The mortality risk increased by 28% for each unit increase in the Charlson Comorbidity Index (CCI) when analyzed as a continuous variable (OR: 1.28; 95% CI: 1.12\u0026ndash;1.46; p=0.001). Similarly, the categorical model showed a 34% increase per unit (OR: 1.34; 95% CI: 1.12\u0026ndash;1.59; p=0.001). Higher Candida scores (OR: 2.26; 95% CI: 1.91\u0026ndash;2.68; p\u0026lt;0.001), intubation (OR: 1.53; p=0.027), the presence of shock (OR: 1.66; p=0.011), and TPN use (OR: 3.49; 95% CI: 2.30\u0026ndash;5.29; p\u0026lt;0.001) were also independently associated with mortality. The model\u0026rsquo;s AUC was 0.81 (95% CI: 0.77\u0026ndash;0.85), indicating good, discrimination (Figure 1).\u003c/p\u003e\n\u003cp\u003eThe comparative analysis of the 30-day mortality rates between the groups showed that the mortality rate of the candidemia-only cases (67.8%) was significantly lower than the remaining (p=0.024). \u0026nbsp;However, despite the high mortality rate observed among earthquake-injury group cases (%84.7%), no statistical significance has been identified (p=0.775).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study, utilizinga comparative approach, analyzed candidemia attacks in patients with SARS-CoV-2, earthquake-related injuries, and candidemia-only cases. The objective was to analyze the impact of changes in various parameters, including laboratory tests, invasive interventions, organ function-related conditions, antifungal strategies, and pathogen diversity, on survival. Initially, it is evident that the elevated mean age and the presence of multiple comorbidities in the majority of cases underline the significance of host characteristics in candidemia. It is imperative to acknowledge that the course can be expected to progress more rapidly, particularly when additional conditions arise. The present findings are consistent with the literature indicating that advanced age and a high comorbidity burden are significant factors in the development of candidemia in individuals (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe multivariate logistic regression analysis that included Candida score, catheter duration, intubation, presence of shock, and TPN use, the Candida score was found to be an independent predictor of mortality, suggesting that the Candida score may be useful in identifying high-risk patients with a threshold value of \u0026ge;\u0026thinsp;3 and may be particularly beneficial in early diagnosis similarly to the findings of Le\u0026oacute;n et al. and other studies\u0026rsquo; findings (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Nevertheless, research findings emphasize that the negative predictive value of this score may be limited in ICU patients and that it must be supported by colony density (e.g. fungal load on the catheter surface) or biomarkers such as 1,3-β-D-glucan (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCatheter duration and the presence of intubation were notably associated with mortality and are consistent with previously reported cohort analyzes (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Particularly, prolonged catheterization may contribute to the development of invasive infections by increasing Candida colonization. Intubation, on the other hand, increases the risk of secondary infections associated with mechanical ventilation (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Furthermore, shock and the use of TPN have been identified as significant determinants of mortality. The presence of shock is indicative of hemodynamicinstability and organ failure, while TPN has been shown to facilitate fungal translocation by disrupting gastrointestinal mucosal integrity and accelerate the development of infection (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMoreover, it was shown that the risk of mortality was approximately three times higher in cases not receiving antifungal treatment (OR: 2.91; 95% CI: 1.58\u0026ndash;5.36), that each point increase in the CCI score increased the risk of mortality by 28% (OR: 1.28; 95% CI: 1.12\u0026ndash;1.46), and that each mg/dL increase in creatinine level is associated with a significant increase in the risk of death (OR: 1.23; 95% CI: 1.07\u0026ndash;1.41). Although the area under the ROC curve (AUC) value of our model was calculated as 0.81, indicating that the model's performance in predicting mortality is at a good level, the interpretation of these results must be approached with a degree of caution, as they may also be attributable to the general condition of the patients and the severity of their critical illness (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe three times higher risk for mortality finding for cases who have not received antifungal treatment highlights the necessity of the specific treatment. In this study, the mortality risk in cases where antifungal treatment was not initiated was found to be approximately three times higher. Notwithstanding the initiation of treatment, the preservation of life can become significantly more challenging, even in patients who receive antifungal treatment more than 48 hours after the onset of symptoms (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFurthermore, an increase in the CCI (Charlson Comorbidity Index) score by one point was observed to result in a 28% increase in the risk of mortality (OR: 1.28; 95% CI: 1.12\u0026ndash;1.46), thereby demonstrating that the comorbidity burden is a critical determinant in the course of candidemia. As indicated by earlier research findings, an elevated CCI score has been demonstrated to serve as an independent predictor of mortality risk in patients diagnosed with candidemia (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn accordance with the results of a large-scale surveillance study, the present study identified a significant association between elevated creatinine levels and an increased mortality risk, with a 1 mg/dL increase in creatinine levels resulting in an odds ratio of 1.23 (95% confidence interval: 1.07\u0026ndash;1.41), suggesting that renal dysfunction has a significant impact on prognosis (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe Area Under the ROC Curve (AUC) value of 0.81, which indicates the good performance of our multivariate model in predicting mortality, is similar to the findings of prognostic models previously developed in different ICU cohorts (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, the results of our model may also reflect the general critical condition of the patients and the additional risks they are exposed to in the intensive care unit; therefore, they should be interpreted with caution. Our findings show that the initiation of early antifungal treatment, comorbidity assessment, and close monitoring of organ functions are critical elements in predicting mortality, but the robustness of our model needs to be reinforced with external validation studies conducted in different centers.\u003c/p\u003e\u003cp\u003eIn terms of the distribution of Candida species, non-albicans Candida (NAC) species were found to be predominant, with species such as \u003cem\u003eC. parapsilosis\u003c/em\u003e being particularly prominent. This distribution is consistent with global trends, and the virulence traits of NAC species, such as azole resistance and biofilm formation, may contribute to differences in treatment response (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The delayed initiation of antifungal treatment, or the failure to initiate treatment, has been identified as a significant risk factor for mortality. A delay of more than two days between obtaining a positive culture sample and initiating treatment was found to be significantly associated with mortality, as has been previously reported in the literature (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eLaboratory parameters such as elevated creatinine, increased procalcitonin, and thrombocytopenia, which can be considered early indicators of clinical deterioration by reflecting the severity of sepsis and organ dysfunction, have been found to be associated with mortality, as in the results of other studies (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA growing body of literature has emerged on the subject of co-occurring cases of SARS-CoV-2 and candidemia, referred as Covid-19 associated candidemia (CAC), indicating a marked increase in candidemia rates, particularly among ICU patients. A recent series of systematic reviews have reported a CAC prevalence of around 4.3%, emphasising that mortality occurred in approximately 68% of these cases (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). This phenomenon is hypothesised to be attributable to the immunosuppressive effect of SARS-CoV-2, in conjunction with the concomitant administration of steroids and tocilizumab. As demonstrated in this study, which evaluates the impact of extraordinary circumstances, such as disasters and pandemics, on the incidence and mortality of candidemia, the mortality rate is notably higher in cases of candidemia accompanied by SARS-CoV-2, which is in parallel to the existing literature on the subject (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe increase in candidemia observed in the post-earthquake period is a topic that has received limited attention in the literature. Nevertheless, the literature has reported the increase in the incidence of fungal infections in the aftermath of natural disasters. Traumatic injuries, the increased need for intensive care, disruptions in healthcare infrastructure, and contaminated environmental conditions are shown as the main reasons for this rise in incidence rates, especially in the case of major earthquakes. Research undertaken following the Wenchuan earthquake revealed the presence of various fungal pathogens, including Candida species, in wound and blood cultures (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). In a similar manner, the 2008 Sichuan earthquake saw the identification of numerous fungal agents, chiefly \u003cem\u003eCandida tropicalis\u003c/em\u003e. Furthermore, an escalation in mucormycosis and aspergillosis cases was documented in the aftermath of disasters such as tsunamis and tornadoes (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Research conducted in T\u0026uuml;rkiye following the 2023 earthquake also detected a substantial surge in fungal infection rates, particularly among trauma patients admitted to intensive care units (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). This study revealed a substantial increase in \u003cem\u003eC. parapsilosis\u003c/em\u003e isolates following the earthquake, indicating a potential association between this species and the transmission via hospital equipment and healthcare workers' hands as proposed in other studies (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). In general, these findings suggest that the distribution of candidemia in earthquake-related cases in our study is consistent with those observed in studies conducted on invasive fungal infections in disaster conditions. Our findings underscores the significance of maintaining infection control practices during disaster situations, thereby reinforcing the importance of infection prevention strategies in healthcare settings.\u003c/p\u003e\u003cp\u003eThe study is subject to certain limitations. Primarily, due to the retrospective nature of the investigation, it was not possible to access all the clinical data; consequently, antifungal susceptibility test results could not be provided for the entire study group. Furthermore, the identification of species was not performed using molecular methods, but rather conventional methods, which has been demonstrated to increase the margin of error, particularly in the diagnosis of rare species and important pathogens such as \u003cem\u003eC. auris\u003c/em\u003e (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Moreover, the incorporation of advanced biomarker analyses, which have the potential to yield more reliable results with respect to negative predictive value, was not feasible within the scope of this study.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study presents a sound analysis that highlights the role of the Candida score in predicting mortality, in addition to known risk factors such as advanced age, high comorbidity score, intubation, catheter duration, presence of shock, and TPN use. The research also demonstrates changes in candidemia patterns during the SARS-CoV-2 pandemic and a major seismic event, and provides statistical support for the effect of antifungal treatment timing on mortality. The analysis reveals a correlation between the predominance of non-Candida albicans species and the emergence of antifungal resistance and treatment failure. It is hypothesised that the multivariate model with good predictive powerpresented in this study will contribute to the evaluation of empirical antifungal treatment decisions in high-risk intensive care patients in conjunction with clinical, microbiological, and epidemiological data.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eALT\u003c/strong\u003e: Alanine aminotransferase\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAPC\u003c/strong\u003e: Article Processing Charge\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUC\u003c/strong\u003e: Area under the curve\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCCI\u003c/strong\u003e: Charlson Comorbidity Index\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCRP\u003c/strong\u003e: C-reactive protein\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCS\u003c/strong\u003e: Candida score\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCVP\u003c/strong\u003e: Central venous pressure\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICU\u003c/strong\u003e: Intensive care unit\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNAC\u003c/strong\u003e: Non-albicans Candida\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eROC\u003c/strong\u003e: Receiver operating characteristic\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSARS-CoV-2\u003c/strong\u003e: Severe Acute Respiratory Syndrome Coronavirus-2\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e: Standard deviation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSPSS\u003c/strong\u003e: Statistical Package for the Social Sciences\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTPN\u003c/strong\u003e: Total parenteral nutrition\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWBC\u003c/strong\u003e: White blood cell\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproved by the Toros University Scientific Research and Publication Ethics Committee (No:16, 23 January 2024), in accordance with the Declaration of Helsinki.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMU conceived and designed the study. MU and B\u0026Ccedil;D performed data collection and statistical analysis. MU interpreted the data. MU and B\u0026Ccedil;D drafted the manuscript. All authors read and approved the final version.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1.Department of Infectious Diseases and Clinical Microbiology, Mersin City Training and Research Hospital, Mersin, T\u0026uuml;rkiye\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eArendrup MC, Patterson TF. Multidrug-resistant Candida: epidemiology, molecular mechanisms, and treatment. J Infect Dis. 2017;216(Suppl_3):S445\u0026ndash;51.\u003c/li\u003e\n\u003cli\u003ePappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62(4):e1\u0026ndash;50.\u003c/li\u003e\n\u003cli\u003eBassetti M, et al. Epidemiology, species distribution, and risk factors for candidemia in a large European cohort study. J Antimicrob Chemother. 2019;74(11):3237-3244.\u003c/li\u003e\n\u003cli\u003eMagill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al. Multistate point-prevalence survey of health care\u0026ndash;associated infections. N Engl J Med. 2014;370(13):1198\u0026ndash;208.\u003c/li\u003e\n\u003cli\u003eCornely OA, et al. ESCMID guideline for the diagnosis and management of Candida diseases 2018: Part 1: clinical manifestations, risk factors and therapy of candidemia and invasive candidiasis. Clin Microbiol Infect. 2019;25(8):920-940.\u003c/li\u003e\n\u003cli\u003eLortholary O, et al. Delays in initiation of appropriate antifungal therapy in invasive candidiasis: A worldwide multicenter observational study. J Infect. 2017;74(4):382-390.\u003c/li\u003e\n\u003cli\u003eMiceli MH, et al. The evolving epidemiology of candidemia in a tertiary care center: a 20-year experience. Mycoses. 2019;62(10):924-930.\u003c/li\u003e\n\u003cli\u003eChowdhary A, et al. Global epidemiology, species distribution and antifungal susceptibility of Candida auris: an emerging multidrug-resistant fungal pathogen. Lancet Infect Dis. 2018;18(11):e349-e354.\u003c/li\u003e\n\u003cli\u003eAgha A, et al. The impact of the COVID-19 pandemic on the epidemiology of candidemia in an Italian tertiary care hospital. J Clin Microbiol. 2021;59(11):e0094721.\u003c/li\u003e\n\u003cli\u003eKoehler P, et al. COVID-19 associated pulmonary aspergillosis. Clin Microbiol Infect. 2021;27(1):14-21.\u003c/li\u003e\n\u003cli\u003eKanj SS, et al. Post-disaster infection surveillance in Lebanon. JAMA. 2015;313(15):1563-1564.\u003c/li\u003e\n\u003cli\u003eRiquelme M, et al. Impact of natural disasters on the epidemiology of infectious diseases. Curr Opin Infect Dis. 2020;33(4):342-348.\u003c/li\u003e\n\u003cli\u003eLe\u0026oacute;n C, Ruiz-Santana S, Saavedra P, et al. A bedside scoring system (\u0026ldquo;Candida score\u0026rdquo;) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med. 2006;34(3):730\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eCharlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373‐383.\u003c/li\u003e\n\u003cli\u003eHuang AM, Newton D, Kunapuli A, et al. Impact of rapid organism identification via MALDI-TOF combined with antimicrobial stewardship team intervention in adult patients with bacteremia and candidemia. Clin Infect Dis. 2013;57(9):1237\u0026ndash;45.\u003c/li\u003e\n\u003cli\u003eRauseo AM, Olsen MA, Forest CP, et al. The true burden of candidemia: which patients are most at risk? J Fungi (Basel). 2021;7(3):203.\u003c/li\u003e\n\u003cli\u003eShigemura K, Nakano Y, Yamashita M, et al. Candida score and colonization index to predict candidemia in intensive care unit. Antibiotics (Basel). 2022;11(6):788.\u003c/li\u003e\n\u003cli\u003eDe Carolis E, Vella A, Torelli R, et al. Use of (1,3)-\u0026beta;-D-glucan assay in diagnosing invasive fungal infections: a retrospective analysis of real-life data. BMC Infect Dis. 2017;17(1):763.\u003c/li\u003e\n\u003cli\u003eProwle JR, Echeverri JE, Ligabo EV, et al. Acquired bloodstream infection in the intensive care unit: incidence and attributable mortality. Crit Care. 2011;15(2):R100.\u003c/li\u003e\n\u003cli\u003eKullberg BJ, Arendrup MC. Invasive Candidiasis. Lancet. 2015;387(10013):1467\u0026ndash;78. doi:10.1016/S0140-6736(15)01090-9.\u003c/li\u003e\n\u003cli\u003eBarchiesi F, Orsetti E, Gesuita R, Skrami E, Manso E, Candidemia Study Group. Epidemiology, clinical characteristics, and outcome of candidemia in a tertiary referral center in Italy from 2010 to 2014. J Antimicrob Chemother. 2017;72(7):2021\u0026ndash;8. doi:10.1093/jac/dkx092.\u003c/li\u003e\n\u003cli\u003eFern\u0026aacute;ndez J, Bert F, Nicolas-Chanoine MH. The challenges of hospital-acquired bloodstream infections in the 21st century. Clin Microbiol Infect. 2016;22(4):331\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eTimsit JF, Azoulay E, Schwebel C, et al. Empirical micafungin treatment and survival without invasive fungal infection in adults with ICU-acquired sepsis, Candida colonisation, and multiple organ failure: the EMPIRICUS randomised clinical trial. Lancet Infect Dis. 2016;16(4):500\u0026ndash;11.\u003c/li\u003e\n\u003cli\u003eRauseo AM, Olsen MA, et al. Prognostic indicators in patients with candidemia: a population-based study. J Fungi (Basel). 2021;7(3):191.\u003c/li\u003e\n\u003cli\u003eChen CY, Huang SY, Tien FM, et al. Candidaemia in adult patients with haematological malignancies: risk factors for mortality. J Antimicrob Chemother. 2016;71(2):506\u0026ndash;13.\u003c/li\u003e\n\u003cli\u003eMorrell M, Fraser VJ, Kollef MH. Delaying empiric treatment of Candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicrob Agents Chemother. 2005;49(9):3640\u0026ndash;3645. doi:10.1128/AAC.49.9.3640-3645.2005.\u003c/li\u003e\n\u003cli\u003eGarey KW, Rege M, Pai MP, Mingo DE, Suda KJ, Turpin RS, Bearden DT. Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study. Clin Infect Dis. 2006;43(1):25\u0026ndash;31. doi:10.1086/504810.\u003c/li\u003e\n\u003cli\u003eLortholary O, Renaudat C, Sitbon K, Madec Y, Denoeud-Ndam L, Wolff M, et al. Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002\u0026ndash;2010). Intensive Care Med. 2014;40(9):1303\u0026ndash;12. doi:10.1007/s00134-014-3408-3.\u003c/li\u003e\n\u003cli\u003eArendrup MC, Dzajic E, Jensen RH, Johansen HK, Kjaeldgaard P, Knudsen JD, et al. Epidemiological changes with potential implication for antifungal prescription recommendations for fungaemia: data from a nationwide fungemia surveillance programme. Clin Microbiol Infect. 2020;26(6):796\u0026ndash;803. doi:10.1016/j.cmi.2019.10.016.\u003c/li\u003e\n\u003cli\u003ePuig-Asensio M, Fern\u0026aacute;ndez-Ruiz M, Aguado JM, Merino P, Lora-Pablos D, Guinea J, et al. Epidemiology and predictive factors for early and late mortality in candidemia: a population-based surveillance in Spain. Clin Microbiol Infect. 2014;20(4):O245\u0026ndash;54. doi:10.1111/1469-0691.12380\u003c/li\u003e\n\u003cli\u003eColombo AL, de Almeida J\u0026uacute;nior JN, Slavin MA, et al. Candida and invasive mould diseases in non-neutropenic critically ill patients and patients with haematological cancer. Lancet Infect Dis. 2017;17(11):e344\u0026ndash;56.\u003c/li\u003e\n\u003cli\u003eArikan-Akdagli S, Ergon C, Ener B, et al. Clinical and microbiological features of Candida bloodstream infections in Turkish intensive care units: a prospective multicenter study. Mycoses. 2020;63(7):721\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eMachado M, Valerio M, \u0026Aacute;lvarez-Ur\u0026iacute;a A, et al. Invasive fungal infections during COVID-19: a retrospective study in a tertiary-care hospital. J Fungi (Basel). 2021;7(4):291.\u003c/li\u003e\n\u003cli\u003eReizine F, Massart N, Mansour A, Fedun Y, Machut A, Vacheron CH, Savey A, Friggeri A, Lepape A; REAREZO study group. Relationship between SARS-CoV-2 infection and ICU-acquired candidemia in critically ill medical patients: a multicenter prospective cohort study. Crit Care. 2024;28(1):320. doi:10.1186/s13054-024-05104-w.\u003c/li\u003e\n\u003cli\u003eBaten N, Wajed S, Talukder A, Masum MHU, Rahman MM. Coinfection of fungi with SARS-CoV-2 is a detrimental health risk for COVID-19 patients. Beni Suef Univ J Basic Appl Sci. 2022;11(1):64. doi:10.1186/s43088-022-00245-9.\u003c/li\u003e\n\u003cli\u003eWang S, Li Y, Chi C, Guo L, Wang H, Zhang C, et al. Clinical analysis of infections after Wenchuan earthquake: fungal pathogens in wound and blood cultures. Chin J Traumatol. 2010;13(5):275-9. PMID:20880446; PMCID:PMC3086233.\u003c/li\u003e\n\u003cli\u003eSeidel D, et al. Impact of climate change and natural disasters on fungal infections. Lancet Microbe. 2024;5(2):e84-e94. doi:10.1016/S2666-5247(24)00039-9.\u003c/li\u003e\n\u003cli\u003eAvcu G, et al. Infections after the earthquake disaster. J Pediatr Res. 2023;10.4274/jpr.galenos.2023.56767.\u003c/li\u003e\n\u003cli\u003eMesini A, Principe L, Massimo D, et al. Candida parapsilosis bloodstream infections in neonatal and pediatric intensive care units: epidemiology and prevention. J Fungi (Basel). 2021;7(6):470.\u003c/li\u003e\n\u003cli\u003eChen H, Zhou X, Ren B, Cheng L. The regulation of hyphae growth in Candida albicans. Virulence. 2020;11(1):337\u0026ndash;48.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. \u0026nbsp;Initial analysis results of the demographic and clinical data\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"668\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"8\" style=\"width: 452px;\"\u003e\n \u003cp\u003eGroups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003eCandidemia \u0026amp; SARS-CoV-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 116px;\"\u003e\n \u003cp\u003eCandidemia \u0026amp; Earthquake-related injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003eCandidemia only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003eVariable Rates\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003en=305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003en=173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003en=261\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003en=739\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 82px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e42.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e22.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e35.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e48.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.76\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e40.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e24.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e35.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e51.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 82px;\"\u003e\n \u003cp\u003eIntubated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e38.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e22.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e38.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e53.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.07\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e44.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e24.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e31.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e341\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e46.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 82px;\"\u003e\n \u003cp\u003eTPN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e29.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e27.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e43.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e22.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.003\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e44.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e22.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e33.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e574\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e77.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 82px;\"\u003e\n \u003cp\u003eCVP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e27.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e28.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e43.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e8.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.053\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e287\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e42.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e22.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e34.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e673\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e91.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 82px;\"\u003e\n \u003cp\u003eCatheterization period (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e1-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e33.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e24.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e42.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e20.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.004\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e4-7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e41.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e24.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e33.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e330\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e44.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e7\u0026lt;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e51.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e18.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e29.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e26.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eNot catheterized\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e27.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e28.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e43.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e8.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 82px;\"\u003e\n \u003cp\u003eShock\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e38.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e25.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e36.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e442\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e59.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.146\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e45.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e20.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e33.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e297\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e40.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 82px;\"\u003e\n \u003cp\u003eDialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e261\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e40.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e23.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e35.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e638\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e86.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.652\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e43.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e19.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e36.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e13.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 82px;\"\u003e\n \u003cp\u003eBurns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e41.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e23.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e35.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e707\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e95.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.812\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e37.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e21.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e40.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e4.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 82px;\"\u003e\n \u003cp\u003eSurgical intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e39.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e22.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e38.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e629\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e85.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.0001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e51.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e30.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e17.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e14.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 82px;\"\u003e\n \u003cp\u003eKidney Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e39.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e24.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e36.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e87.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.142\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e50.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e18.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e30.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e12.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMalignant neoplasm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e41.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e23.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e34.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e571\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e77.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.691\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e39.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e22.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e38.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e22.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 82px;\"\u003e\n \u003cp\u003eCorticosteroid need\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e43.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e21.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e34.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e663\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e89.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.0001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e18.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e43.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e38.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e10.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 82px;\"\u003e\n \u003cp\u003eAntifungal treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e54.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e17.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e28.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e25.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.0006\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eAnidulafungin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e37.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e21.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e40.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e29.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eCaspofungin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e26.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e36.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e36.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e10.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eVoriconazole/Amphotericin B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e33.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e41.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eFluconazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e39.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e24.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e33.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 82px;\"\u003e\n \u003cp\u003e*Candida Species\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eCandida albicans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e26.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e16.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e56.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e29.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.0001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eCandida glabrata\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e48.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e34.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e16.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e5.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eCandida parapsilosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e44.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e24.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e30.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e39.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eCandida tropicalis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e50.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e24.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e24.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e22.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eOther Candida spp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e42.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e7.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e3.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 82px;\"\u003e\n \u003cp\u003eAlbicans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eAlbicans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e26.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e16.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e56.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e29.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.0001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eNon-Albicans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e47.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e26.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e26.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e523\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e70.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMortality (30 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eDeceased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e47.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e22.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e30.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e67.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.0001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eAlive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e27.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e26.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e46.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e32.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 82px;\"\u003e\n \u003cp\u003eC. albicans-related mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eDeceased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 57px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e71.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e50.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e67.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.0001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 82px;\"\u003e\n \u003cp\u003eNon-Albicans related mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eDeceased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 57px;\"\u003e\n \u003cp\u003e79.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e51.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e63.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e67.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;0.0001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e523\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003eMean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 116px;\"\u003e\n \u003cp\u003eMean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003eMean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003eMean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e67.44\u0026plusmn;18.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 116px;\"\u003e\n \u003cp\u003e65.86\u0026plusmn;17.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e63.84\u0026plusmn;17.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e65.8\u0026plusmn;17.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.038\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eAlbumin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2.79\u0026plusmn;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 116px;\"\u003e\n \u003cp\u003e2.82\u0026plusmn;0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e2.86\u0026plusmn;0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2.82\u0026plusmn;0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.423\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eALT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e52.81\u0026plusmn;149.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 116px;\"\u003e\n \u003cp\u003e38.75\u0026plusmn;96.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e43.26\u0026plusmn;85.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e46.14\u0026plusmn;118.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.640\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eCreatinin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.55\u0026plusmn;1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 116px;\"\u003e\n \u003cp\u003e1.31\u0026plusmn;1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.4\u0026plusmn;1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.44\u0026plusmn;1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.105\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eWBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e13709.12\u0026plusmn;10371.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 116px;\"\u003e\n \u003cp\u003e13378.18\u0026plusmn;10824.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e12031.64\u0026plusmn;9354.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e13039.2\u0026plusmn;10149.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.060\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eNeutrophils\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7750.52\u0026plusmn;7493.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 116px;\"\u003e\n \u003cp\u003e8656.09\u0026plusmn;9923.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e7732.36\u0026plusmn;9950.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7956.1\u0026plusmn;9006.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.376\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eLymphocytes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4354.51\u0026plusmn;7549.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 116px;\"\u003e\n \u003cp\u003e3592.18\u0026plusmn;5756.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e3763.43\u0026plusmn;5697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3967.29\u0026plusmn;6537.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.836\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003ePlatelets\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e187091.48\u0026plusmn;153273.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 116px;\"\u003e\n \u003cp\u003e225020.81\u0026plusmn;154421.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e211674.33\u0026plusmn;155513.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e204652.91\u0026plusmn;154910.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.006\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eProcalcitonin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.6\u0026plusmn;16.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 116px;\"\u003e\n \u003cp\u003e5.41\u0026plusmn;12.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e8.19\u0026plusmn;17.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.71\u0026plusmn;16.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.002\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eCRP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e15.64\u0026plusmn;9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 116px;\"\u003e\n \u003cp\u003e12.92\u0026plusmn;9.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e14.08\u0026plusmn;9.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e14.45\u0026plusmn;9.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.002\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eDuration of hospitalization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e22.82\u0026plusmn;13.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 116px;\"\u003e\n \u003cp\u003e21.58\u0026plusmn;11.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e21.1\u0026plusmn;12.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e21.92\u0026plusmn;12.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.243\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eCCI score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.19\u0026plusmn;1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 116px;\"\u003e\n \u003cp\u003e1.1\u0026plusmn;1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.25\u0026plusmn;1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.19\u0026plusmn;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.355\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eCandida Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2.3\u0026plusmn;1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 116px;\"\u003e\n \u003cp\u003e1.86\u0026plusmn;1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e1.82\u0026plusmn;1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2.03\u0026plusmn;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt;p\u0026lt;0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*The other Candida species group includes the following species: Candida auris, Candida ciferrii, Candida dubliniensis, Candida guilliermondii, Candida kefyr, Candida krusei, and Candida lusitaniae.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Laboratory parameters of ICU patients with candidemia according to 30-day mortality status (n=739)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"595\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eOverall Median (Min\u0026ndash;Max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eSurvivors Median (Min\u0026ndash;Max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eNon-survivors Median (Min\u0026ndash;Max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eLeukocyte (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e10560.0 (100\u0026ndash;78490)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e9140.0\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(130\u0026ndash;76610)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e11360.0\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(100\u0026ndash;78490)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eNeutrophil (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e5330.0 (3.85\u0026ndash;79990.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4320.0 (4.31\u0026ndash;59770.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e5695.0\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(3.85\u0026ndash;79990.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eLymphocyte (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1510.0\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(10\u0026ndash;55920)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1920.0\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(90\u0026ndash;53570)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e1360.0\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(10\u0026ndash;55920)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003ePlatelet (\u0026times;10\u0026sup3;/\u0026micro;L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e171000.0 (6000\u0026ndash;1240000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e247000.0 (8000\u0026ndash;990000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e152500.0 (6000\u0026ndash;1240000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eALT (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e20.0\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(7\u0026ndash;2158)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e21.0\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(7\u0026ndash;892)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e19.0\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(7\u0026ndash;2158)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.643\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eCreatinine (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.98\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(0.1\u0026ndash;6.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.71\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(0.1\u0026ndash;4.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e1.1\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(0.11\u0026ndash;6.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eProcalcitonin (ng/mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1.38\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(0.01\u0026ndash;75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.58\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(0.01\u0026ndash;75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e2.05\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(0.01\u0026ndash;75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eCRP (mg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e13.9\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(0.11\u0026ndash;71.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e9.27\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(0.11\u0026ndash;71.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e15.4\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(0.16\u0026ndash;51.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* Mann-Whitney U\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Candidemia, Intensive Care Units, Mortality, Antifungal Agents, COVID-19, Earthquakes","lastPublishedDoi":"10.21203/rs.3.rs-7612495/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7612495/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eCandidemia is a serious bloodstream infection with high mortality, particularly in intensive care unit (ICU) patients. Its epidemiology is influenced by evolving practices, resistance, and extraordinary circumstances such as pandemics and disasters. This study aimed to analyze candidemia epidemiology, risk factors, and outcomes, focusing on the impact of the COVID-19 pandemic and a major earthquake in southern Türkiye.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe retrospectively analyzed 739 adult ICU patients diagnosed with candidemia between 2018 and 2023 at a tertiary referral center in Türkiye. Patients were grouped as pre-pandemic, COVID-19, and post-earthquake periods. Clinical characteristics, Candida species distribution, antifungal treatment timing, and mortality rates were compared. Logistic regression was performed to identify independent predictors of 30-day mortality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eThe overall 30-day mortality rate was 68.5%. Mortality was significantly higher during the COVID-19 period (91.1%) compared to the pre-pandemic (57.6%) and post-earthquake (64.7%) periods (p\u0026lt;0.001). Non-albicans Candida species accounted for 62.3% of isolates, with C. parapsilosis being most frequent. Delayed initiation of antifungal therapy (\u0026gt;48h) and failure to remove central venous catheters were associated with increased mortality. Multivariable analysis identified higher Charlson comorbidity index, Candida score, septic shock, mechanical ventilation, and delayed antifungal therapy as independent predictors of mortality (AUC=0.81).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003eCandidemia in ICU patients is associated with high mortality, particularly under crisis conditions such as the COVID-19 pandemic and earthquake disaster. Early antifungal initiation and prompt catheter removal remain critical to improving outcomes. These findings highlight the need for strengthened infection control strategies and disaster preparedness in resource-challenged setting\u003c/p\u003e","manuscriptTitle":"Impact of COVID-19 and Earthquake Disaster on Candidemia in the ICU: Mortality and Treatment Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-03 16:18:49","doi":"10.21203/rs.3.rs-7612495/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-13T06:59:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-12T04:09:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"190679845254301531644413499259055460575","date":"2026-03-12T03:52:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"102091912618570629379500159362087821732","date":"2025-12-21T22:21:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-19T03:04:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"150156663668448340680869111523493894262","date":"2025-12-10T01:00:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-21T16:39:06+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-18T07:04:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-16T07:22:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-16T07:22:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-09-14T12:02:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"149eaa5b-3bd9-4b86-8a22-137f3738b1c6","owner":[],"postedDate":"October 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T16:02:04+00:00","versionOfRecord":{"articleIdentity":"rs-7612495","link":"https://doi.org/10.1186/s12879-026-13436-x","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2026-04-25 15:57:29","publishedOnDateReadable":"April 25th, 2026"},"versionCreatedAt":"2025-10-03 16:18:49","video":"","vorDoi":"10.1186/s12879-026-13436-x","vorDoiUrl":"https://doi.org/10.1186/s12879-026-13436-x","workflowStages":[]},"version":"v1","identity":"rs-7612495","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7612495","identity":"rs-7612495","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}