Retrospective analysis of mortality and Candida isolates of 75 patients with candidemia: a single hospital experience

Abstract

The mortality rate for candidemia is approximately 30%–60%. However, prognostic factors in patients with candidemia have not yet been elucidated in detail. The aim of the present study was to analyze prognostic factors for candidemia using the mortality rate and Candida isolates of patients with candidemia. Seventy-five patients with candidemia were analyzed between January 2007 and December 2013. The main outcome of this study was the 30-day mortality rate after the diagnosis of candidemia. The acute physiology and chronic health evaluation II score (APACHE II score) was measured in 34 patients (45.3%). Odds ratios (ORs) for death due to candidemia were analyzed using a multivariate stepwise logistic regression analysis. Twenty (26.6%) patients died within 30 days of being diagnosed with candidemia. Non-survivors had a significantly higher APACHE II score (n=7, mean; 18.9±4.5) than that of survivors (n=27, mean; 14.0±5.0). Advanced age (OR =1.1, 95% confidence interval =1.01–1.23, P=0.04) was a significant risk factor for a high mortality rate, whereas removal of a central venous catheter (OR =0.03, 95% confidence interval =0.002–0.3, P=0.01) was associated with a lower mortality rate. Seventy-six Candida spp. were isolated from blood cultures: Candida albicans 28 (36.8%), Candida parapsilosis 23 (30.2%), Candida guilliermondii 16 (21.0%), Candida glabrata four (5.2%), Candida tropicalis two (2.6%), and Candida spp. three (3.9%) that could not be identified. C. parapsilosis was the most frequently isolated species in younger patients (<65 years), whereas C. albicans was the most frequently isolated in elderly patients (≥65 years). Physicians who treat candidemia need to consider removing the central venous catheter and pay attention to the general condition of patients, particularly that of elderly patients.

Epidemiology and prognosis of candidaemia in elderly patients

“…As may be expected, fewer cases of haematological cancer or transplantation were found among elderly patients . These patients present a high index of suspicion of infection and early empirical antifungal therapy is frequently prescribed .…”

“…These patients present a high index of suspicion of infection and early empirical antifungal therapy is frequently prescribed . In addition, the elderly patients in our series did not commonly present other risk factors, such as malignant neoplasm, ICU admission, central line or parenteral nutrition as detected in other similar studies . A study focused in elderly patient (defined as patients >65 years) parenteral nutrition, CVC and glycopeptide antibiotics were found to be the strongest risk factors for candidaemia .…”

Increasing candidaemia incidence from 2004 to 2015 with a shift in epidemiology in patients preexposed to antifungals

“…Although C. albicans is reported as the main cause of candidaemia worldwide, several reports from India, indicated C. tropicalis as the most prevalent candidaemia‐causing species . Moreover, it has been shown that the species distribution can also vary on a regional scale and even on a local scale within the hospital …”

Cytographic changes on BC-6800 Haematological Analyzer related to the presence ofCandida albicansin peripheral blood. A new tool to suspect candidemia?

“…For this purpose, various amounts of C. albicans were added to PB samples to simulate BSI, which in vivo are characterised by the presence of both extracellular and phagocytised yeasts 1 2 8. Each blood sample was analysed in the BC-6800 in different times.…”