The epidemiology, antifungal use and risk factors of death in elderly patients with candidemia: a multicentre retrospective study

Abstract

BackgroundThe elderly patients affected by candidemia are growing in proportion to inpatients, but available data are limited. We aimed to determine the epidemiology, antifungal management and clinical risk factors of death in the elderly population with candidemia in China.MethodsThis retrospective study included 63 elderly (≥65 years) and 84 younger patients (16–60 years) at 4 tertiary hospitals. Multivariable logistic regression model was used to identify independent risk factors of death in elderly patients.ResultsThe distribution of Candida species did not differ between elderly and younger patients (p >0.05). Resistance to fluconazole and voriconazole for non-Candida albicans species in elderly patients was approximately double that in younger patients. Host-related risk factors (e.g., underlying solid tumour, diabetes mellitus and chronic renal failure) and hospital-related factors (e.g., prior stay in an intensive care unit, mechanical ventilation, central vascular and urethral catheters placement) were identified more common in elderly patients. Elderly patients less often received triazoles and were less likely to receive antifungal therapies mostly because elderly or their guardians quit antifungal therapies. APACHE II scores and 30-day mortality were higher for elderly than younger patients (31.7% vs. 16.7%, p =0.032). For elderly patients, antifungal therapy administered before microbiological documentation was the only protective factor for death, whereas absence of antifungal therapies, receipt of mechanical ventilation and APACHE II score ≥20 were independent predictors of death.ConclusionsElderly patients with candidemia had poor prognoses characterized by certain host and hospital-related risk factors and special pathogen resistance features. More awareness of the burden of this disease is required, and the absence of antifungal therapies should be avoided to improve the prognoses of elderly patients with this severe infection.

Candidemia in the elderly: What does it change?

“…Data from the literature often report older age as an independent factor for mortality in patients with candidemia [2, 5–7, 9, 11, 12]. In our cohort, elderly patients (>65 years) represented 62% of the entire study group (188/302).…”

“…Similarly, two recent studies showed that 30-day mortality increased from 17% to 32% and from 45% to 70% in younger and older patients, respectively [9, 11]. This wide variation of mortality among studies can be due to several reasons such as the definition of elderly, the proportion of immunocompromised patients included (i.e.…”

Epidemiology and prognosis of candidaemia in elderly patients

“…Invasive fungal infections are characterised by their increasing incidence and high mortality . Elderly patients constitute a group that commonly suffers from candidaemia which has been related to a high rate of chronic conditions, such as diabetes mellitus, chronic renal failure or solid tumour …”

“…Therefore, having a better understanding of some aspects related to risk factors, clinical presentation and therapeutic approach could be decisive for better management of these infections . Although the prognostic factors of candidaemia in the general population has been extensively studied, specific prognostic factors for the geriatric population has received little attention …”

Best Practices for Drug Prescribing in Older Adults: A Call for Action

“…Voriconazole can be used as step-down treatment of C. glabrata or C. krusei infections (if susceptibility results suggest that they are active) or if additional mould coverage is required [2,3]. In the elderly, colonisation and infections with non-albicans species, including C. glabrata, has been shown to be increased [6,33,34]. In recent studies, the susceptibility to fluconazole and voriconazole of non-albicans species isolated from the elderly was approximately doubled when compared with the susceptibility of isolates obtained from younger patients [6,7,35].…”