Risk Factors for Mortality in Patients with Candidemia and the Usefulness of a Candida Score.
- Author:
In Ki MOON
1
;
Eun Jung LEE
;
Hyo Chul KANG
;
Shi Nae YU
;
Jee Wan WEE
;
Tae Hyong KIM
;
Eun Joo CHOO
;
Min Hyuk JUN
;
Se Yoon PARK
Author Information
1. Division of Infection Department of Internal Medicine, SoonChunHyang University Seoul Hospital, Korea. shegets@schmc.ac.kr
- Publication Type:Original Article
- Keywords:
Candidemia;
Candida score;
Antifungal therapy
- MeSH:
Anti-Bacterial Agents;
Antifungal Agents;
APACHE;
Blood;
Candida*;
Candidemia*;
Cohort Studies;
Colon;
Diabetes Mellitus;
General Surgery;
Hospitals, Teaching;
Humans;
Intensive Care Units;
Logistic Models;
Male;
Methods;
Mortality*;
Odds Ratio;
Parenteral Nutrition, Total;
Renal Dialysis;
Retrospective Studies;
Risk Factors*
- From:Korean Journal of Medical Mycology
2013;18(3):59-65
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Although effective antifungal agents for the treatment of candidemia have recently been introduced, the mortality rate attributed to candidemia remains high (19~49%). OBJECTIVE: This study aimed at evaluating the risk factors for mortality in patients with candidemia and at assessing the usefulness of a Candida Score in these patients. METHODS: A cohort of patients with positive blood cultures for Candida species was retrospectively analyzed at Soonchunhyang University Hospital, a 750-bed teaching hospital, from May 2003 to February 2012. The Candida Score was calculated by assigning 1 point to any of total parenteral nutrition (TPN), surgery, or multifocal Candida species colonization, and 2 points to severe sepsis. RESULTS: Sixty patients (68.3% men; mean age (standard deviation [SD]), 61.8 [18.9] years) with blood cultures positive for Candida species were identified. Most patients had been admitted to an intensive care unit (48 [80%]), were receiving broad-spectrum antibiotics (37 [61.7%]), had TPN (29 [48.3%]), had diabetes mellitus (23 [38.3%]), and were receiving hemodialysis (10 [16.7%]). The mean (SD) Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 19.60 (8.8). Twenty-three patients (38.3%) had a Candida Score >2.5. The Candida species causing infection included C. albicans (41 [68.3%]), C. tropicalis (7 [11.7%]), C. parapsilosis (4 [6.7%]), C. krusei (3 [5%]), C. glabrata (3 [5%]), C. guilliermondii (1 [1.7%]), and C. catenulata (1 [1.7%]). Only 32 patients (53.3%) received adequate antifungal treatment. The candidemia-related mortality rate was 61.7% (n = 37 patients). Multivariate logistic regression analysis demonstrated that a high APACHE II score (adjusted odds ratio [aOR], 1.2; 95% confidence interval [95% CI], 1.0~1.3; p = 0.01), presence of a malignancy (aOR, 14.8; 95% CI, 2.5~88.0; p = 0.003), and treatment with an antifungal agent (aOR, 0.2; 95% CI, 0.0~1.0; p = 0.048) were associated with disease-related mortality. CONCLUSION: The risk factors for mortality in patients with candidemia are a high APACHE II scores and presence of a malignancy. However, the sensitivity of the Candida Score was not high (38.3%). New methods to rapidly identify candidemia and avoid delays in treatment with appropriate antifungal therapy are needed.
