AustralieFrV1, Main, Exploration, bibRecord, 002243

Characteristics and risk factors for 28-day mortality of hospital acquired fungemias in ICUs: data from the EUROBACT study

Identifieur interne : 002243 ( Main/Exploration ); précédent : 002242; suivant : 002244

Characteristics and risk factors for 28-day mortality of hospital acquired fungemias in ICUs: data from the EUROBACT study

Auteurs : José-Artur Paiva [Portugal] ; José Manuel Pereira [Portugal] ; Alexis Tabah [France, Australie] ; Adam Mikstacki [Pologne] ; Frederico Bruzzi De Carvalho ; Despoina Koulenti [Australie, Grèce] ; Stéphane Ruckly [France] ; Nahit Çakar [Turquie] ; Benoit Misset [France] ; George Dimopoulos [Grèce] ; Massimo Antonelli [Italie] ; Jordi Rello [Espagne] ; Xiaochun Ma [République populaire de Chine] ; Barbara Tamowicz [Pologne] ; Jean-François Timsit [France]

Source :

Critical Care [ 1364-8535 ] ; 2016.

RBID : PMC:4784333

Descripteurs français

KwdFr :
- Adulte d'âge moyen, Antifongiques (usage thérapeutique), Facteurs de risque, Femelle, Fongémie (anatomopathologie), Fongémie (mortalité), Humains, Incidence, Infection croisée (mortalité), Maladie iatrogène, Mortalité hospitalière (tendances), Mâle, Sujet âgé, Unités de soins intensifs (), Études prospectives.
MESH :
- anatomopathologie : Fongémie.
- mortalité : Fongémie, Infection croisée.
- tendances : Mortalité hospitalière.
- usage thérapeutique : Antifongiques.
- Adulte d'âge moyen, Facteurs de risque, Femelle, Humains, Incidence, Maladie iatrogène, Mâle, Sujet âgé, Unités de soins intensifs, Études prospectives.

English descriptors

KwdEn :
- Aged, Antifungal Agents (therapeutic use), Cross Infection (mortality), Female, Fungemia (mortality), Fungemia (pathology), Hospital Mortality (trends), Humans, Iatrogenic Disease, Incidence, Intensive Care Units (statistics & numerical data), Male, Middle Aged, Prospective Studies, Risk Factors.
MESH :
- chemical , therapeutic use : Antifungal Agents.
- mortality : Cross Infection, Fungemia.
- pathology : Fungemia.
- statistics & numerical data : Intensive Care Units.
- trends : Hospital Mortality.
- Aged, Female, Humans, Iatrogenic Disease, Incidence, Male, Middle Aged, Prospective Studies, Risk Factors.

Abstract

Background

To characterize and identify prognostic factors for 28-day mortality among patients with hospital-acquired fungemia (HAF) in the Intensive Care Unit (ICU).

Methods

A sub-analysis of a prospective, multicenter non-representative cohort study conducted in 162 ICUs in 24 countries.

Results

Of the 1156 patients with hospital-acquired bloodstream infections (HA-BSI) included in the EUROBACT study, 96 patients had a HAF. Median time to its diagnosis was 20 days (IQR 10.5–30.5) and 9 days (IQR 3–15.5) after hospital and ICU admission, respectively. Median time to positivity of blood culture was longer in fungemia than in bacteremia (48.7 h vs. 38.1 h; p = 0.0004). Candida albicans was the most frequent fungus isolated (57.1 %), followed by Candida glabrata (15.3 %) and Candida parapsilosis (10.2 %). No clear source of HAF was detected in 33.3 % of the episodes and it was catheter-related in 21.9 % of them. Compared to patients with bacteremia, HAF patients had a higher rate of septic shock (39.6 % vs. 21.6 %; p = 0.0003) and renal dysfunction (25 % vs. 12.4 %; p = 0.0023) on admission and a higher rate of renal failure (26 % vs. 16.2 %; p = 0.0273) at diagnosis. Adequate treatment started within 24 h after blood culture collection was less frequent in HAF patients (22.9 % vs. 55.3 %; p < 0.001). The 28-day all cause fatality was 40.6 %. According to multivariate analysis, only liver failure (OR 14.35; 95 % CI 1.17–175.6; p = 0.037), need for mechanical ventilation (OR 8.86; 95 % CI 1.2–65.24; p = 0.032) and ICU admission for medical reason (OR 3.87; 95 % CI 1.25–11.99; p = 0.020) were independent predictors of 28-day mortality in HAF patients.

Conclusions

Fungi are an important cause of hospital-acquired BSI in the ICU. Patients with HAF present more frequently with septic shock and renal dysfunction on ICU admission and have a higher rate of renal failure at diagnosis. HAF are associated with a significant 28-day mortality rate (40 %), but delayed adequate antifungal therapy was not an independent risk factor for death. Liver failure, need for mechanical ventilation and ICU admission for medical reason were the only independent predictors of 28-day mortality.

Electronic supplementary material

The online version of this article (doi:10.1186/s13054-016-1229-1) contains supplementary material, which is available to authorized users.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4784333

DOI: 10.1186/s13054-016-1229-1
PubMed: 26956367
PubMed Central: 4784333

Affiliations:

Le document en format XML

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<author><name sortKey="Koulenti, Despoina" sort="Koulenti, Despoina" uniqKey="Koulenti D" first="Despoina" last="Koulenti">Despoina Koulenti</name>
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</affiliation>
<affiliation wicri:level="3"><nlm:aff id="Aff7">Department of Critical Care, University Hospital ATTIKON, Medical School University of Athens, Athens, Greece</nlm:aff>
<country xml:lang="fr">Grèce</country>
<wicri:regionArea>Department of Critical Care, University Hospital ATTIKON, Medical School University of Athens, Athens</wicri:regionArea>
<placeName><settlement type="city">Athènes</settlement>
<region nuts="2" type="region">Attique (région)</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Ruckly, Stephane" sort="Ruckly, Stephane" uniqKey="Ruckly S" first="Stéphane" last="Ruckly">Stéphane Ruckly</name>
<affiliation wicri:level="3"><nlm:aff id="Aff4">Outcomerea Organization, Paris, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Outcomerea Organization, Paris</wicri:regionArea>
<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="Aff8">Decision Sciences in Infectious Disease (DescID) Prevention, Control and Care, UMR 1137 Paris Diderot University, Sorbonne, Paris, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Decision Sciences in Infectious Disease (DescID) Prevention, Control and Care, UMR 1137 Paris Diderot University, Sorbonne, Paris</wicri:regionArea>
<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Cakar, Nahit" sort="Cakar, Nahit" uniqKey="Cakar N" first="Nahit" last="Çakar">Nahit Çakar</name>
<affiliation wicri:level="1"><nlm:aff id="Aff9">Department of Anaesthesiology and Intensive Care, Istanbul University and Istanbul Medical School, Istanbul, Turkey</nlm:aff>
<country xml:lang="fr">Turquie</country>
<wicri:regionArea>Department of Anaesthesiology and Intensive Care, Istanbul University and Istanbul Medical School, Istanbul</wicri:regionArea>
<wicri:noRegion>Istanbul</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Misset, Benoit" sort="Misset, Benoit" uniqKey="Misset B" first="Benoit" last="Misset">Benoit Misset</name>
<affiliation wicri:level="4"><nlm:aff id="Aff10">Université Paris Descartes, Paris Sorbonne Cité, Medical-surgical ICU, Groupe hospitalier Paris Saint-Joseph, Paris, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Université Paris Descartes, Paris Sorbonne Cité, Medical-surgical ICU, Groupe hospitalier Paris Saint-Joseph, Paris</wicri:regionArea>
<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
<settlement type="city">Paris</settlement>
</placeName>
<orgName type="university">Université Paris-Descartes</orgName>
</affiliation>
</author>
<author><name sortKey="Dimopoulos, George" sort="Dimopoulos, George" uniqKey="Dimopoulos G" first="George" last="Dimopoulos">George Dimopoulos</name>
<affiliation wicri:level="3"><nlm:aff id="Aff7">Department of Critical Care, University Hospital ATTIKON, Medical School University of Athens, Athens, Greece</nlm:aff>
<country xml:lang="fr">Grèce</country>
<wicri:regionArea>Department of Critical Care, University Hospital ATTIKON, Medical School University of Athens, Athens</wicri:regionArea>
<placeName><settlement type="city">Athènes</settlement>
<region nuts="2" type="region">Attique (région)</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Antonelli, Massimo" sort="Antonelli, Massimo" uniqKey="Antonelli M" first="Massimo" last="Antonelli">Massimo Antonelli</name>
<affiliation wicri:level="3"><nlm:aff id="Aff11">Department of Intensive Care and Anaesthesiology, Policlinico Universitario A. Gemelli-Università Cattolica del Sacro Cuore, Rome, Italy</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Department of Intensive Care and Anaesthesiology, Policlinico Universitario A. Gemelli-Università Cattolica del Sacro Cuore, Rome</wicri:regionArea>
<placeName><settlement type="city">Rome</settlement>
<region nuts="2">Latium</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Rello, Jordi" sort="Rello, Jordi" uniqKey="Rello J" first="Jordi" last="Rello">Jordi Rello</name>
<affiliation wicri:level="4"><nlm:aff id="Aff12">Critical Care Department, Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Critical Care Department, Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona</wicri:regionArea>
<placeName><settlement type="city">Barcelone</settlement>
<region nuts="2" type="region">Catalogne</region>
<settlement type="city">Barcelone</settlement>
</placeName>
<orgName type="university">Université autonome de Barcelone</orgName>
</affiliation>
</author>
<author><name sortKey="Ma, Xiaochun" sort="Ma, Xiaochun" uniqKey="Ma X" first="Xiaochun" last="Ma">Xiaochun Ma</name>
<affiliation wicri:level="1"><nlm:aff id="Aff13">Department of Critical Care Medicine, The First Affiliated Hospital Of China Medical University, Shenyang, China</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea>Department of Critical Care Medicine, The First Affiliated Hospital Of China Medical University, Shenyang</wicri:regionArea>
<wicri:noRegion>Shenyang</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Tamowicz, Barbara" sort="Tamowicz, Barbara" uniqKey="Tamowicz B" first="Barbara" last="Tamowicz">Barbara Tamowicz</name>
<affiliation wicri:level="1"><nlm:aff id="Aff5">Department of Anaesthesiology and Intensive Therapy, Regional Hospital in Poznan, Poznan University of Medical Sciences, Poznan, Poland</nlm:aff>
<country xml:lang="fr">Pologne</country>
<wicri:regionArea>Department of Anaesthesiology and Intensive Therapy, Regional Hospital in Poznan, Poznan University of Medical Sciences, Poznan</wicri:regionArea>
<wicri:noRegion>Poznan</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Timsit, Jean Francois" sort="Timsit, Jean Francois" uniqKey="Timsit J" first="Jean-François" last="Timsit">Jean-François Timsit</name>
<affiliation wicri:level="3"><nlm:aff id="Aff2">Université Grenoble 1, U 823, Albert Bonniot Institute; Team 11: Outcome of mechanically ventilated patients and respiratory cancers, Grenoble, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Université Grenoble 1, U 823, Albert Bonniot Institute; Team 11: Outcome of mechanically ventilated patients and respiratory cancers, Grenoble</wicri:regionArea>
<placeName><region type="region">Auvergne-Rhône-Alpes</region>
<region type="old region">Rhône-Alpes</region>
<settlement type="city">Grenoble</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="Aff4">Outcomerea Organization, Paris, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Outcomerea Organization, Paris</wicri:regionArea>
<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="Aff8">Decision Sciences in Infectious Disease (DescID) Prevention, Control and Care, UMR 1137 Paris Diderot University, Sorbonne, Paris, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Decision Sciences in Infectious Disease (DescID) Prevention, Control and Care, UMR 1137 Paris Diderot University, Sorbonne, Paris</wicri:regionArea>
<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="Aff14">Medical and Infectious Diseases Intensive Care Unit, Bichat University Hospital, Paris Diderot University, Paris, 75018 France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Medical and Infectious Diseases Intensive Care Unit, Bichat University Hospital, Paris Diderot University, Paris</wicri:regionArea>
<placeName><region type="region">Île-de-France</region>
<region type="old region">Île-de-France</region>
<settlement type="city">Paris</settlement>
</placeName>
</affiliation>
</author>
</analytic>
<series><title level="j">Critical Care</title>
<idno type="ISSN">1364-8535</idno>
<idno type="eISSN">1466-609X</idno>
<imprint><date when="2016">2016</date>
</imprint>
</series>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term>
<term>Antifungal Agents (therapeutic use)</term>
<term>Cross Infection (mortality)</term>
<term>Female</term>
<term>Fungemia (mortality)</term>
<term>Fungemia (pathology)</term>
<term>Hospital Mortality (trends)</term>
<term>Humans</term>
<term>Iatrogenic Disease</term>
<term>Incidence</term>
<term>Intensive Care Units (statistics & numerical data)</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Prospective Studies</term>
<term>Risk Factors</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Adulte d'âge moyen</term>
<term>Antifongiques (usage thérapeutique)</term>
<term>Facteurs de risque</term>
<term>Femelle</term>
<term>Fongémie (anatomopathologie)</term>
<term>Fongémie (mortalité)</term>
<term>Humains</term>
<term>Incidence</term>
<term>Infection croisée (mortalité)</term>
<term>Maladie iatrogène</term>
<term>Mortalité hospitalière (tendances)</term>
<term>Mâle</term>
<term>Sujet âgé</term>
<term>Unités de soins intensifs ()</term>
<term>Études prospectives</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antifungal Agents</term>
</keywords>
<keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Fongémie</term>
</keywords>
<keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Cross Infection</term>
<term>Fungemia</term>
</keywords>
<keywords scheme="MESH" qualifier="mortalité" xml:lang="fr"><term>Fongémie</term>
<term>Infection croisée</term>
</keywords>
<keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Fungemia</term>
</keywords>
<keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Intensive Care Units</term>
</keywords>
<keywords scheme="MESH" qualifier="tendances" xml:lang="fr"><term>Mortalité hospitalière</term>
</keywords>
<keywords scheme="MESH" qualifier="trends" xml:lang="en"><term>Hospital Mortality</term>
</keywords>
<keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Antifongiques</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Aged</term>
<term>Female</term>
<term>Humans</term>
<term>Iatrogenic Disease</term>
<term>Incidence</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Prospective Studies</term>
<term>Risk Factors</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr"><term>Adulte d'âge moyen</term>
<term>Facteurs de risque</term>
<term>Femelle</term>
<term>Humains</term>
<term>Incidence</term>
<term>Maladie iatrogène</term>
<term>Mâle</term>
<term>Sujet âgé</term>
<term>Unités de soins intensifs</term>
<term>Études prospectives</term>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>To characterize and identify prognostic factors for 28-day mortality among patients with hospital-acquired fungemia (HAF) in the Intensive Care Unit (ICU).</p>
</sec>
<sec><title>Methods</title>
<p>A sub-analysis of a prospective, multicenter non-representative cohort study conducted in 162 ICUs in 24 countries.</p>
</sec>
<sec><title>Results</title>
<p>Of the 1156 patients with hospital-acquired bloodstream infections (HA-BSI) included in the EUROBACT study, 96 patients had a HAF. Median time to its diagnosis was 20 days (IQR 10.5–30.5) and 9 days (IQR 3–15.5) after hospital and ICU admission, respectively. Median time to positivity of blood culture was longer in fungemia than in bacteremia (48.7 h vs. 38.1 h; <italic>p</italic>
 = 0.0004). <italic>Candida albicans</italic>
 was the most frequent fungus isolated (57.1 %), followed by <italic>Candida glabrata</italic>
 (15.3 %) and <italic>Candida parapsilosis</italic>
 (10.2 %). No clear source of HAF was detected in 33.3 % of the episodes and it was catheter-related in 21.9 % of them. Compared to patients with bacteremia, HAF patients had a higher rate of septic shock (39.6 % vs. 21.6 %; <italic>p</italic>
 = 0.0003) and renal dysfunction (25 % vs. 12.4 %; <italic>p</italic>
 = 0.0023) on admission and a higher rate of renal failure (26 % vs. 16.2 %; <italic>p</italic>
 = 0.0273) at diagnosis. Adequate treatment started within 24 h after blood culture collection was less frequent in HAF patients (22.9 % vs. 55.3 %; <italic>p</italic>
 < 0.001). The 28-day all cause fatality was 40.6 %. According to multivariate analysis, only liver failure (OR 14.35; 95 % CI 1.17–175.6; <italic>p</italic>
 = 0.037), need for mechanical ventilation (OR 8.86; 95 % CI 1.2–65.24; <italic>p</italic>
 = 0.032) and ICU admission for medical reason (OR 3.87; 95 % CI 1.25–11.99; <italic>p</italic>
 = 0.020) were independent predictors of 28-day mortality in HAF patients.</p>
</sec>
<sec><title>Conclusions</title>
<p>Fungi are an important cause of hospital-acquired BSI in the ICU. Patients with HAF present more frequently with septic shock and renal dysfunction on ICU admission and have a higher rate of renal failure at diagnosis. HAF are associated with a significant 28-day mortality rate (40 %), but delayed adequate antifungal therapy was not an independent risk factor for death. Liver failure, need for mechanical ventilation and ICU admission for medical reason were the only independent predictors of 28-day mortality.</p>
</sec>
<sec><title>Electronic supplementary material</title>
<p>The online version of this article (doi:10.1186/s13054-016-1229-1) contains supplementary material, which is available to authorized users.</p>
</sec>
</div>
</front>
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<affiliations><list><country><li>Australie</li>
<li>Espagne</li>
<li>France</li>
<li>Grèce</li>
<li>Italie</li>
<li>Pologne</li>
<li>Portugal</li>
<li>République populaire de Chine</li>
<li>Turquie</li>
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<region><li>Attique (région)</li>
<li>Auvergne-Rhône-Alpes</li>
<li>Catalogne</li>
<li>Latium</li>
<li>Rhône-Alpes</li>
<li>Île-de-France</li>
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<settlement><li>Athènes</li>
<li>Barcelone</li>
<li>Grenoble</li>
<li>Paris</li>
<li>Rome</li>
</settlement>
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<li>Université autonome de Barcelone</li>
</orgName>
</list>
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<name sortKey="Ruckly, Stephane" sort="Ruckly, Stephane" uniqKey="Ruckly S" first="Stéphane" last="Ruckly">Stéphane Ruckly</name>
<name sortKey="Tabah, Alexis" sort="Tabah, Alexis" uniqKey="Tabah A" first="Alexis" last="Tabah">Alexis Tabah</name>
<name sortKey="Timsit, Jean Francois" sort="Timsit, Jean Francois" uniqKey="Timsit J" first="Jean-François" last="Timsit">Jean-François Timsit</name>
<name sortKey="Timsit, Jean Francois" sort="Timsit, Jean Francois" uniqKey="Timsit J" first="Jean-François" last="Timsit">Jean-François Timsit</name>
<name sortKey="Timsit, Jean Francois" sort="Timsit, Jean Francois" uniqKey="Timsit J" first="Jean-François" last="Timsit">Jean-François Timsit</name>
<name sortKey="Timsit, Jean Francois" sort="Timsit, Jean Francois" uniqKey="Timsit J" first="Jean-François" last="Timsit">Jean-François Timsit</name>
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<country name="Australie"><noRegion><name sortKey="Tabah, Alexis" sort="Tabah, Alexis" uniqKey="Tabah A" first="Alexis" last="Tabah">Alexis Tabah</name>
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<name sortKey="Koulenti, Despoina" sort="Koulenti, Despoina" uniqKey="Koulenti D" first="Despoina" last="Koulenti">Despoina Koulenti</name>
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<country name="Pologne"><noRegion><name sortKey="Mikstacki, Adam" sort="Mikstacki, Adam" uniqKey="Mikstacki A" first="Adam" last="Mikstacki">Adam Mikstacki</name>
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<name sortKey="Tamowicz, Barbara" sort="Tamowicz, Barbara" uniqKey="Tamowicz B" first="Barbara" last="Tamowicz">Barbara Tamowicz</name>
</country>
<country name="Grèce"><region name="Attique (région)"><name sortKey="Koulenti, Despoina" sort="Koulenti, Despoina" uniqKey="Koulenti D" first="Despoina" last="Koulenti">Despoina Koulenti</name>
</region>
<name sortKey="Dimopoulos, George" sort="Dimopoulos, George" uniqKey="Dimopoulos G" first="George" last="Dimopoulos">George Dimopoulos</name>
</country>
<country name="Turquie"><noRegion><name sortKey="Cakar, Nahit" sort="Cakar, Nahit" uniqKey="Cakar N" first="Nahit" last="Çakar">Nahit Çakar</name>
</noRegion>
</country>
<country name="Italie"><region name="Latium"><name sortKey="Antonelli, Massimo" sort="Antonelli, Massimo" uniqKey="Antonelli M" first="Massimo" last="Antonelli">Massimo Antonelli</name>
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</country>
<country name="Espagne"><region name="Catalogne"><name sortKey="Rello, Jordi" sort="Rello, Jordi" uniqKey="Rello J" first="Jordi" last="Rello">Jordi Rello</name>
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</country>
<country name="République populaire de Chine"><noRegion><name sortKey="Ma, Xiaochun" sort="Ma, Xiaochun" uniqKey="Ma X" first="Xiaochun" last="Ma">Xiaochun Ma</name>
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Serveur d'exploration sur les relations entre la France et l'Australie

Characteristics and risk factors for 28-day mortality of hospital acquired fungemias in ICUs: data from the EUROBACT study

Characteristics and risk factors for 28-day mortality of hospital acquired fungemias in ICUs: data from the EUROBACT study

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	Serveur d'exploration sur les relations entre la France et l'Australie
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