We provided a set of easily determinable independent predictors of the occurrence of candidemia in CICU patients. Our results provide a rationale for implementing preventive measures in the form of independent predictor control, and initiating antifungal prophylaxis in high-risk CICU patients. 
Candida species are the fourth most frequent isolate in ICU patients with nosocomial bloodstream infections. Predictors of invasive fungal infections in medical/surgical and surgical ICU patients have been provided; however, the cardio-thoracic ICU (CICU) subpopulation exhibits characteristics, such as increased comorbidity, preceding extensive surgery with cardiopulmonary bypass (CPB), and increased postoperative morbidity, which could render these patients particularly susceptible to candidemia. In the present investigation, we sought to construct and prospectively validate logistic regression models of determinants of candi-demia and associated mortality in CICU patients.
The initial, case-control, prospective study was approved by the Review Board of the Onassis Cardiac Surgery Center, Athens, Greece; 4,312 adults, subjected to CPB-employing cardiac operations between March 1997 and October 1999 were candidates for enrollment. Exclusion criteria were immunodeficiency, bacterial infection requiring hospitalization within the month preceding the operation, and preoperative exposure to an invasive device apart from that required for emergency coronary angiography or mechanical circulatory support. Antibiotic prophylaxis included a second-generation cephalosporin in coronary artery bypass grafting (CABG) procedures and a third-generation cephalosporin in conjunction with teicoplanin in-valve replacement and mixed (CABG and valve replacement) procedures.
Following CICU admission, patients received mechanical ventilation with a Siemens 300C ventilator. Ventilatory parameters were adjusted to maintain Pao2 > 70 mm Hg, Paco2 between 35 mm Hg and 45 mm Hg, and inspiratory plateau airway pressure < 30 cm H2O. External positive end-expiratory pressure (PEEPe) was applied to maintain alveolar recruitment. Preventive measures against aspiration of gastric contents (semirecumbent positioning of patients, confirmation of adequate endotracheal tube cuff function by auscultation and manometry every 12 to 24 h, aspiration of subglottic secretions every 4 to 8 h, and use of small-bore nasogastric tubes for any prescribed enteral feeding in conjunction with metoclopramide to prevent duodenal reflux) were taken.
