Independent risk factors for mortality in critically ill patients with candidemia on Italian Internal Medicine Wards

Sbrana, Francesco; Sozio, Emanuela; Bassetti, Matteo; Ripoli, Andrea; Pieralli, Filippo; Azzini, Anna Maria; Morettini, A; Nozzoli, Carlo; Merelli, Maria; Rizzardo, Sebastiano; Bertolino, Giacomo; Carrara, Davide; Scarparo, Claudio; Concia, Ercole; Menichetti, Francesco; Tascini, Carlo

doi:10.1007/s11739-017-1783-9

Cited by 23 publications

(17 citation statements)

References 35 publications

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“…In one of the largest European multicenter trials on the epidemiology of ICU-acquired candidiasis, the 30-day mortality rate was 42% [1]. Similarly, a 30-day-mortality of 45% has been reported after candidemia in internal medicine wards [19]. The French Mycoses study group observed 50% survival in a mixed ICU population 30 days after candidemia [11], which is similar to the findings of a retrospective observation by Ghanem-Zoubi and colleagues [3].…”

Section: Discussionsupporting

confidence: 76%

Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis

Schroeder

Weber

Denker

et al. 2020

Ann. Intensive Care

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Background Despite advances in the management of bloodstream infections (BSI) caused by Candida spp., the mortality still remains high in critically ill patients. The worldwide epidemiology of yeast-related BSI is subject to changing species distribution and resistance patterns, challenging antifungal treatment strategies. The aim of this single-center study was to identify predictors of mortality after 28 and 180 days in a cohort of mixed surgical and medical critically ill patients with candidemia. Methods Patients, who had been treated for laboratory-confirmed BSI caused by Candida spp. in one of 12 intensive care units (ICU) at a University hospital between 2008 and 2017, were retrospectively identified. We retrieved data including clinical characteristics, Candida species distribution, and antifungal management from electronic health records to identify risk factors for mortality at 28 and 180 days using a Cox regression model. Results A total of 391 patients had blood cultures positive for Candida spp. (incidence 4.8/1000 ICU admissions). The mortality rate after 28 days was 47% (n = 185) and increased to 60% (n = 234) after 180 days. Age (HR 1.02 [95% CI 1.01–1.03]), a history of liver cirrhosis (HR 1.54 [95% CI 1.07–2.20]), septic shock (HR 2.41 [95% CI 1.73–3.37]), the Sepsis-related Organ Failure Assessment score (HR 1.12 [95% CI 1.07–1.17]), Candida score (HR 1.25 [95% CI 1.11–1.40]), and the length of ICU stay at culture positivity (HR 1.01 [95% CI 1.00–1.01]) were significant risk factors for death at 180 days. Patients, who had abdominal surgery (HR 0.66 [95% CI 0.48–0.91]) and patients, who received adequate (HR 0.36 [95% CI 0.24–0.52]) or non-adequate (HR 0.31 [95% CI 0.16–0.62]) antifungal treatment, had a reduced mortality risk compared to medical admission and no antifungal treatment, respectively. Conclusions The mortality of critically ill patients with Candida BSI is high and is mainly determined by disease severity, multiorgan dysfunction, and antifungal management rather than species distribution and susceptibility. Our results underline the importance of timely treatment of candidemia. However, controversies remain on the optimal definition of adequate antifungal management.

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Section: Discussionsupporting

confidence: 76%

Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis

Schroeder

Weber

Denker

et al. 2020

Ann. Intensive Care

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“…Additionally, candidaemia remains associated with high-mortality rates, prolonged hospital stays and increased healthcare costs [1, 4–7]. Overall, mortality rates among patients range from 19.6% to 67% worldwide [1, 6, 8–12] and the major risk factors for candidaemia include receipt of parenteral nutrition, exposure to broad spectrum antibiotics, presence of central venous catheter (CVC), prior surgery and ICU stay [13, 14]. Even though C. albicans overall accounts for the majority of Candida spp.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology, risk factors and outcomes of Candida albicans vs. non-albicans candidaemia in adult patients in Northeast China

Zhang

Song

et al. 2019

Epidemiol. Infect.

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This study aimed to evaluate the clinical characteristics, risk factors and outcomes of adult patients with candidaemia caused by C. albicans vs. non-albicans Candida spp. (NAC). All adult hospitalised cases of candidaemia (2012–2017) at a tertiary hospital in Shenyang were included in the retrospective study, and a total of 180 episodes were analysed. C. parapsilosis was the most frequently isolated species (38.3%), followed by C. albicans (35.6%), C. glabrata (13.9%), C. tropicalis (10%) and others (2.2%). As initial antifungal therapy, 75.0%, 3.9%, 5.6% and 2.2% of patients received fluconazole, caspofungin, micafungin and voriconazole, respectively. Multivariate analyses revealed that total parenteral nutrition was associated with an increased risk of NAC bloodstream infections (BSI) (OR 2.535, 95% CI (1.066–6.026)) vs. C. albicans BSI. Additionally, the presence of a urinary catheter was associated with an increased risk of C. albicans BSI (OR 2.295 (1.129–4.666)) vs. NAC BSI. Moreover, ICU stay (OR 4.013 (1.476–10.906)), renal failure (OR 3.24 (1.084–9.683)), thrombocytopaenia (OR 7.171 (2.152–23.892)) and C. albicans (OR 3.629 (1.352–9.743)) were independent risk factors for candidaemia-related 30-day mortality, while recent cancer surgery was associated with reduced mortality risk (OR 26.479 (2.550–274.918)). All these factors may provide useful information to select initial empirical antifungal agents.

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“…The incidence of septic shock is only collaterally mentioned in reports on candidemia in the general populations and it ranges from 12.9 to 49.0% in recent studies [16][17][18]. However, only three series have specifically focused on the incidence of septic shock among candidemic patients.…”

Section: Discussionmentioning

confidence: 99%

“…17 Medicine Department School of Medicine, Universidad Complutense de Madrid, Madrid, Spain. 18 CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Udine, Spain.…”

Section: Acknowledgementsmentioning

confidence: 99%

Factors associated with the development of septic shock in patients with candidemia: a post hoc analysis from two prospective cohorts

et al. 2020

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Background: Almost one third of the patients with candidemia develop septic shock. The understanding why some patients do and others do not develop septic shock is very limited. The objective of this study was to identify variables associated with septic shock development in a large population of patients with candidemia. Methods: A post hoc analysis was performed on two prospective, multicenter cohort of patients with candidemia from 12 hospitals in Spain and Italy. All episodes occurring from September 2016 to February 2018 were analyzed to assess variables associated with septic shock development defined according to The Third International Consensus Definition for Sepsis and Septic Shock (Sepsis-3). Results: Of 317 candidemic patients, 99 (31.2%) presented septic shock attributable to candidemia. Multivariate logistic regression analysis identifies the following factors associated with septic shock development: age > 50 years (OR 2.57, 95% CI 1.03-6.41, p = 0.04), abdominal source of the infection (OR 2.18, 95% CI 1.04-4.55, p = 0.04), and admission to a general ward at the time of candidemia onset (OR 0.21, 95% CI, 0.12-0.44, p = 0.001). Septic shock development was independently associated with a greater risk of 30-day mortality (OR 2.14, 95% CI 1.08-4.24, p = 0.02). Conclusions: Age and abdominal source of the infection are the most important factors significantly associated with the development of septic shock in patients with candidemia. Our findings suggest that host factors and source of the infection may be more important for development of septic shock than intrinsic virulence factors of organisms.

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Independent risk factors for mortality in critically ill patients with candidemia on Italian Internal Medicine Wards

Cited by 23 publications

References 35 publications

Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis

Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis

Epidemiology, risk factors and outcomes of Candida albicans vs. non-albicans candidaemia in adult patients in Northeast China

Factors associated with the development of septic shock in patients with candidemia: a post hoc analysis from two prospective cohorts

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