Candidaemia in an Irish tertiary referral hospital: epidemiology and prognostic factors

Abstract

There were two parts to this study. Part 1 evaluated the epidemiology of Candida bloodstream isolates within the Southern Health Board (SHB) of Ireland from 1992 to 2003 by retrospective surveillance of all such isolates of patients reported from SHB hospitals to our laboratory database during that period. Part 2 reviewed candidaemia cases occurring in Cork University Hospital (CUH) from 1999 to 2003 using surveillance of all positive blood culture isolates in CUH microbiology laboratory during the 5-year period. In part 1, 250 Candida bloodstream isolates were reported in the SHB over 12 years. There was a pattern of decreasing percentage of C. albicans with time. Whereas in part 2, 63 cases of candidaemia were identified in CUH from 1999 to 2003. Candida albicans constituted 50% of all isolates, while C. parapsilosis and C. glabrata accounted for 21.2% and 18.2% respectively. Average annual incidence rate was 0.48 episodes/1000 admissions and 0.70 episodes/10 000 patient-days. Vascular catheters were the commonest source of candidaemia (61.9%) followed by the urinary tract (12.7%). Risk factors included exposure to multiple antibiotics (75%); central vascular catheterization (73%); multiple colonization sites (71%); severe gastrointestinal (GI) dysfunction (54%) and acute renal failure (43%). Crude 7-day and 30-day mortality rates were 20.6% and 39.7% respectively. Logistic regression multivariate analysis identified the following to be independent predictors for mortality: age > or =65 years [odds ratio (OR) 7.2, P = 0.013]; severe GI dysfunction (OR 10.6, P = 0.01); acute renal failure (OR 7.6, P = 0.022); recent/concurrent bacteraemia (OR 5.2, P = 0.042); endotracheal intubation (OR 7.7, P = 0.014); while major surgery was associated with a better prognosis (OR 0.05, P = 0.002). Appropriate antifungal treatment was also found to be associated with survival (Fisher's exact test, P < 0.001). The epidemiology of Candida bloodstream isolates within our health board had changed over the years. Incidence and mortality of candidaemia were relatively high in our hospital. Dysfunction of major organ systems and recent bacteraemia were found to predict mortality.

A Randomized, Blinded, Multicenter Trial of Lipid-Associated Amphotericin B Alone versus in Combination with an Antibody-Based Inhibitor of Heat Shock Protein 90 in Patients with Invasive Candidiasis

“…For C. parapsilosis, this rate was 2%. In studies that correlated early deaths (within 7 days of candidemia) with candidiasis, the mortality rates were 21% [28] and 22% [29].…”

“…This was usually due to gram-negative bacterial infection and was often associated with complications of abdominal surgery. Recent or concomitant bacteremia, abdominal surgery, deep organ involvement, and multiple-organ failure all correlate with a poor prognosis in patients with candidiasis [22,[28][29][30].…”

Diagnostic Issues, Clinical Characteristics, and Outcomes for Patients with Fungemia

“…The crude 30-day mortality was 30 to 40% in most population-based studies enrolling patients until the turn of the millennium (2,4,12,14,16,29,41,42,49,52) but was lower in recent studies (16,17,36) and higher for ICU patients (7,33), patients infected with C. glabrata (54), and patients with delayed initiation of appropriate antifungal treatment (20,34). Because timing and diagnostic sensitivity are still major issues in the management of fungemia, an understanding of diagnostic features, risk groups, and epidemiology is of utmost importance for selection of patients who may benefit from early antifungal treatment and for selection of the most appropriate antifungal agent before species identification is available.…”

Comparison of Nosocomial Candidemia of Pediatric and Adult Cases in 2-Years Period at a Turkish University Hospital

“…Although there have been numerous studies of candidemia in adults [2,[5][6][7][8]] data on pediatric populations [9][10][11][12] are still limited. The aim of this study was to compare the etiology and risk factors of nosocomial candidemia among pediatric and adult patients at a university hospital in 2007-2009.…”

“…Several studies have determined the risk factors fungal infections. These risk factors include the length of stay in the intensive care unit, the use of intravascular catheters, malignancy, surgical operations, chemotherapy, antimicrobial agents and steroid use [2,[5][6][7][8][9].…”