Impact of Nutritional Assessment on the Clinical Outcomes of Patients with Non-albicans Candidemia: A Multicenter Study

Abstract

Several studies have demonstrated that malnutrition is a negative prognostic factor for clinical outcomes. However, there is limited evidence for the effect of malnutrition on clinical outcomes in patients with candidemia. We investigated the relationship between malnutrition and all-cause 28-day mortality among patients with non-albicans candidemia. Between July 2011 and June 2014, all adult patients with non-albicans candidemia, including C. tropicalis, C. glabrata, C. parapsilosis and so on, were enrolled. The Malnutrition Universal Screening Tool (MUST) scores were used to determine the patients’ nutritional status before the onset of candidemia. A total of 378 patients were enrolled; 43.4% developed septic shock and 57.1% had a high risk of malnutrition (MUST ≥ 2). The all-cause 28-day mortality rate was 40.7%. The Cox proportional hazards model revealed that C. tropicalis (HR, 2.01; 95% CI, 1.24–3.26; p = 0.005), Charlson comorbidity index (HR, 1.10; 95% CI, 1.03–1.18; p = 0.007), Foley catheter use (HR, 1.68; 95% CI, 1.21–1.35; p = 0.002), concomitant bacterial infections (HR, 1.55; 95% CI, 1.11–2.17; p = 0.010), low platelet count (HR, 3.81; 95% CI, 2.45–5.91; p < 0.001), not receiving antifungals initially (HR, 4.73; 95% CI, 3.07–7.29; p < 0.001), and MUST ≥ 2 (HR, 1.54; 95% CI, 1.09–2.17; p = 0.014) were independently associated with all-cause 28-day mortality. A simple screening tool for nutritional assessment should be used for patients with non-albicans candidemia to detect early clinical deterioration, and a tailored nutritional care plan should be established for malnourished individuals, to improve their clinical outcomes.

Oral candida lesions and Candida tropicalis: Potential prognostic markers in end‐of‐life cancer patients

“…Although there are no reports on the relationship between oral C. tropicalis and prognosis, studies on intensive care units and human immunodeficiency virus patients have shown a link between C. tropicalis as a deep infection and high mortality rates 25 . The mechanisms by which C. tropicalis worsens prognosis include its adhesion behavior, biofilm formation, hemolytic activity, enzyme secretion, and seeding ability 26,27 . Since this study did not investigate the deep C. tropicalis infections, it is unclear whether local oral infection is related to prognosis.…”

“…25 The mechanisms by which C. tropicalis worsens prognosis include its adhesion behavior, biofilm formation, hemolytic activity, enzyme secretion, and seeding ability. 26,27 Since this study did not investigate the deep C. tropicalis infections, it is unclear whether local oral infection is related to prognosis. Patients with C. tropicalis infection had significantly lower oral mucosal moisture levels.…”

Frecuencia y factores de riesgo para fungemia por especies de Candida

“…Se ha visto que la desnutrición se asocia a una disminución en la fagocitosis, una menor concentración de IL-2 (41), a estados de inmunosupresión (42), a un aumento en el riesgo de infecciones nosocomiales (43-45) y desenlaces desfavorables en los pacientes con candidemia (40,46,47). Con base en esto, la plantea la hipótesis de que la desnutrición se comporta como factor de riesgo para candidemia resistente al fluconazol, ya que esta infección es casi exclusivamente nosocomial y la fagocitosis mediada por macrófagos e IL-2 influyen en su control inmune (48,49).…”

“…Con base en esto, la plantea la hipótesis de que la desnutrición se comporta como factor de riesgo para candidemia resistente al fluconazol, ya que esta infección es casi exclusivamente nosocomial y la fagocitosis mediada por macrófagos e IL-2 influyen en su control inmune (48,49). Además, se ha observado una fuerte asociación entre la candidemia, la inmunosupresión (50, 51) y la malnutrición, lo que a su vez, empeora los desenlaces (40,46,47).…”

A scoring system based on novel biomarkers and clinical risk factors to predict invasive candidiasis in immunocompetent critically ill patients

“…Previous studies have found that plasma levels of inflammatory cytokines [Interleukin-1β (IL-1β), Tumor necrosis factor-α (TNF-α), and Interferon-γ (IFN-γ)] and clinical inflammatory markers [C-reactive protein (CRP) and neutrophils] are significantly increased in patients with IC ( Chumpitazi et al, 2014 ; Akin et al, 2015 ; Wunsch et al, 2021 ). Furthermore, several previous studies have shown that patients with IC in the ICU are at a high risk of malnutrition, which is associated with poor clinical prognosis ( Piazza et al, 2004 ; Lee et al, 2021 ). Therefore, patients with IC in the ICU exhibit extremely severe systemic inflammation and poor nutritional status.…”