Candidemia in a Portuguese tertiary care hospital: Analysis of a 2-year period

Pinto-Magalhães, S.; Martins, A.; Lacerda, Sheylla Nadjane Batista; Filipe, Rita; Prista‐Leão, Beatriz; Pinheiro, Dolores; Silva‐Pinto, André; Santos, Lurdes

doi:10.1016/j.mycmed.2019.08.002

Cited by 29 publications

(24 citation statements)

References 30 publications

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“…In accordance with other studies [17-19, 24, 25, 30, 32, 35, 36], C. albicans was the most common cause of candidaemia in the whole hospital, but the proportion of non-C. albicans infections was higher than that of C. albicans infections. Moreover, the proportions of C. glabrata in surgical, internal medicine and paediatric wards were the highest, which is different from other studies in China [18,19,[35][36][37] but similar to other studies in other countries [4,22,27,29,32]. This may be due to the large number of elderly patients and the increasing use of azole antifungal agents.…”

Section: Discussioncontrasting

confidence: 87%

A seven-year surveillance study of the epidemiology, antifungal susceptibility, risk factors and mortality of candidaemia among paediatric and adult inpaitents in a tertiary teaching hospital in China

Zeng

Ding

Tian

et al. 2020

Preprint

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Background: There are no current national estimates of the candidaemia burden in China, and epidemiological candidaemia data from the underdeveloped region of China are lacking. Methods: A 7-year retrospective study was carried out to analyse the prevalence, species distribution, antifungal susceptibility, risk factors and inpatient mortality of candidaemia among paediatric and adult patients in a regional tertiary teaching hospital in China. Results: During the seven-year study period, a total of 201 inpatients with candidaemia were identified. The median age of the patients was 65 years (range, 1 day to 92 years), and 114 of the patients (56.7%) were male. The mean annual incidence of candidaemia was 0.26 cases per 1,000 admissions (0.42 cases per 1,000 paediatric admissions vs 0.24 cases per 1,000 adult admissions, P<0.05). Candida albicans was the most common fungal species (81/201, 40.3%) in all patients, Candida glabrata was the most common fungal species (18/35, 51.4%) in paediatric patients. Most isolates were susceptible to flucytosine (99.0%) and amphotericin B (99.0%), and the activity of antifungal agents against Candida species was no significant difference in satisfaction between paediatric and adult patients(P>0.05). The all-cause mortality rate was 20.4% (paediatric patients: 11.4% vs adult patients:22.3%, P>0.05). Fewer univariate predictors of poor outcomes were identified for paediatric patients than for adult patients (4 vs 11 predictors). Respiratory dysfunction and septic shock were independent predictors of 30-day mortality for all patients. Conclusions: The epidemiological data of candidaemia in paediatric and adult patients are only different in the distributions of Candida species and the mean annual incidence of candidaemia. Flucytosine and amphotericin B can be used as first-choice agents when no antifungal susceptibility test results are available.

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Section: Discussioncontrasting

confidence: 87%

A seven-year surveillance study of the epidemiology, antifungal susceptibility, risk factors and mortality of candidaemia among paediatric and adult inpaitents in a tertiary teaching hospital in China

Zeng

Ding

Tian

et al. 2020

Preprint

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“…A recent study from Taiwan reported a significant association with survival outcome as well 37 . However, other previous studies have not found a significant difference, 38‐40 despite survivors having higher Equal Candida Scores than non‐survivors. The patient number was smaller in these studies.…”

Section: Discussionmentioning

confidence: 87%

Persistent vs non‐persistent candidaemia in adult patients in 2007‐2016: A retrospective cohort study

Ala-Houhala

2020

Mycoses

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Mycoses. 2020;63:617-624. | 617 wileyonlinelibrary.com/journal/myc | INTRODUC TI ONCandida is a major cause of nosocomial infections, 1 and candidaemia causes significant mortality ranging between 30% and 45%. [2][3][4][5] Furthermore, candidaemia generates significant healthcare costs. 2 Its main complications include metastatic infection foci and death. 6 Persistent candidaemia (PC) is frequently recognised as another complication of candidaemia. Underlying factors that can influence the persistence of blood culture positivity in candidaemia Summary Objectives: Persistent candidaemia (PC) is a recognised complication of candidaemia. Our objective was to evaluate risk factors and clinical significance of PC in adult patients.Methods: This is a retrospective, cohort study. We compared PC with non-PC. All patients with blood cultures positive for Candida species were identified from a microbiological database in the hospital district of Helsinki and Uusimaa from 2007 to 2016. PC was defined as an isolation of the same Candida species from positive blood culture for ≥5 days. Results: PC criteria were fulfilled by 75/350 patients (21.4%). No significant difference emerged between persistent and non-persistent cases caused by non-albicans Candida species (37.3% vs 35.1%, P = .742). The length of hospital stay before onset of candidaemia was longer before PC (hospital stay > 7 days; 73.3% vs 59.6%, P = .043).No significant impact on 30-day mortality was observed (20.0% vs 15.5%, P = .422).Using multivariable regression analysis, we found the presence of central venous catheter (CVC) (OR = 2.71, 95% CI 1.31-5.59), metastatic infection foci (OR 3.60, 95% CI 1.66-7.79) and ineffective empirical treatment (OR = 3.31, 95% CI 1.43-7.65) to be independent risk factors for PC. In subgroup analysis, early source control was identified as a protective factor against PC (30.5% vs 57.7%, P = .002). Conclusion:The presence of CVC, metastatic infection foci and ineffective empirical treatment were independently associated with PC in adult patients. Active search for and treatment of metastatic infection foci and removal of CVC are key elements for preventing PC. K E Y W O R D S adult patients, central venous catheter, metastatic infection foci, Persistent candidaemia

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“…The correlation between quality indicator scores and mortality has not been uniformly demonstrated. Huang and colleagues 11 showed a correlation between higher scores and survival while a study from Portugal failed to show any such association 21 . However, quality improvement may not always lead to a reduction in mortality, although that would be the most desirable benefit.…”

Section: Discussionmentioning

confidence: 99%

Candidaemia in the elderly: Epidemiology, management and adherence to the European Confederation of Medical Mycology quality indicators

Bal

Palchaudhuri

2020

Mycoses

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Summary Background Candidaemia in the elderly has not been extensively investigated. Objectives We compared the management of candidaemia in the elderly patients (age ≥65 years) and the very elderly subgroup of patients (age ≥75 years) with those belonging to the younger group (age <65 years) using the European Confederation of Medical Mycology (ECMM) Quality (EQUAL) standard. Patients & Methods Over a 10‐year period (April 2011‐March 2020), patients with candida bloodstream infection were identified. Data pertaining to demographics, clinical risk factors, antifungal treatment, central venous catheter and investigations such as echocardiogram and fundoscopy were obtained from electronic sources and medical case notes. Results A total of 174 episodes of candidaemia were recorded, comprising of 74 episodes in younger patients and 100 in the elderly, of whom 56 were in the very elderly patients. Of the 177 Candida species recovered, 79 were Candida albicans. EQUAL scores were analysed for 148 patients. The mean score was significantly lower in the elderly (10.4) and the very elderly (9.7) patients compared to the patients in the younger age group (12.19) (P < .01). In particular, this was due to lower blood culture volume drawn (P < .01) and, in the very elderly group, significantly lower scores for the quality indicators pertaining to echocardiogram and fundoscopy (P = .03). The overall mean EQUAL score was 11.16 (median 11; interquartile range 8‐14). The 30‐day survival was 68% and was similar between all groups. Conclusions Areas of improvement were identified in the management of candidaemia in the elderly patients.

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Candidemia in a Portuguese tertiary care hospital: Analysis of a 2-year period

Abstract: Background: Candidemia is a nosocomial infection of increasing importance, associated with high morbidity and mortality. The aim of this study is to describe the species distribution, risk factors, management and outcomes of patients with candidemia.

Cited by 29 publications

References 30 publications

A seven-year surveillance study of the epidemiology, antifungal susceptibility, risk factors and mortality of candidaemia among paediatric and adult inpaitents in a tertiary teaching hospital in China

A seven-year surveillance study of the epidemiology, antifungal susceptibility, risk factors and mortality of candidaemia among paediatric and adult inpaitents in a tertiary teaching hospital in China

Persistent vs non‐persistent candidaemia in adult patients in 2007‐2016: A retrospective cohort study

Candidaemia in the elderly: Epidemiology, management and adherence to the European Confederation of Medical Mycology quality indicators

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