Inflammatory response and clinical course of adult patients with nosocomial bloodstream infections caused by Candida spp.

Abstract

Candida spp. are an important cause of nosocomial bloodstream infection (nBSI) and are associated with significant morbidity and mortality. An historical cohort study was performed to evaluate the clinical course of 60 randomly selected adult patients with nBSIs caused by Candida spp. Patients with BSI caused by Candida albicans (n = 38) and non-albicans spp. (n = 22) were compared with 80 patients with Staphylococcus aureus BSI by serial systemic inflammatory response syndrome (SIRS) and APACHE II scores. The patients had a mean age of 52 years, the length of hospital stay before BSI averaged 21 days, and 57% of patients required care in an intensive care unit before BSI. The mean APACHE II score was 17 on the day of BSI, and 63% of BSIs were caused by C. albicans. Antifungal therapy within the first 24 h of onset of BSI was appropriate in 52% of patients. Septic shock occurred in 27% of patients, and severe sepsis in an additional 8%. Overall mortality was 42%, and the 7-day mortality rate was 27%. The inflammatory response and clinical course were similar for patients with BSI caused by C. albicans and non-albicans spp. In univariate analysis, progression to septic shock was correlated with high overall mortality, as was an APACHE II score >25 at the onset of BSI. In multivariate analysis, the APACHE II score at the onset of BSI and a systemic inflammatory response independently predicted overall mortality, but the 7-day mortality rate was only predicted independently by the APACHE II score. Clinical course and mortality in patients with Candida BSI were predicted by systemic inflammatory response and APACHE II score, but not by the infecting species.

IL-17 and Therapeutic Kynurenines in Pathogenic Inflammation to Fungi

“…A generalized and sustained inflammatory reaction also predicts poor prognosis in patients with Candida spp. bloodstream infection (20). Most prominently, in patients with chronic granulomatous disease (CGD) a hyperinflammatory phenotype and a defective fungal (typically Aspergillus fumigatus) clearance have long been known to benefit each other (21).…”

Assessment of the In Vitro Kinetic Activity of Caspofungin against Candida glabrata

“…Over the last two decades, Candida albicans has been replaced by the non-albicans Candida species, especially C. glabrata, as the cause of candidemia and invasive candidiasis (36). Fluconazole resistance and reduced susceptibility to azole antifungals, especially fluconazole, may explain the increasing prevalence of infections due to C. glabrata.…”

Therapeutische oder prophylaktische Vakzination bei Pilzinfektionen

“…Als Ursache für nosokomiale Sepsis liegen Candida-Spezies an 4. Stelle in den USA mit einer Infektionsrate von 8% [29]. Die Hälfte dieser Infektionen wird bei Intensivpatienten beobachtet.…”