Epidemiology and prognosis of candidaemia in elderly patients

Abstract

The aim of the study was to analyse the epidemiology and prognosis of candidaemia in elderly patients. We performed a comparison of clinical presentation of candidaemia according to age and a study of hazard factors within a prospective programme performed in 29 hospitals. One hundred and seventy-six episodes occurred in elderly patients (>75 years), 227 episodes in middle-aged patients (61-75 years) and 232 episodes in younger patients (16-60 years). Central venous catheter, parenteral nutrition, neutropenia, immunosuppressive therapy and candidaemia caused by Candida parapsilosis were less frequent in elderly patients. These patients received inadequate antifungal therapy (57.3%) more frequently than middle-aged and younger patients (40.5% P < .001). Mortality during the first week (20%) and 30 days (42%) was higher in elderly patients. The variables independently associated with mortality in elderly patients during the first 7 days were acute renal failure (OR: 2.64), Pitt score (OR: 1.57) and appropriate antifungal therapy (OR: 0.132). Primary candidaemia (OR: 2.93), acute renal failure (OR: 3.68), Pitt score (OR: 1.38), appropriate antifungal therapy (OR: 0.3) and early removal of the central catheter (OR: 0.47) were independently associated with 30-day mortality.In conclussion, inadequate antifungal treatment is frequently prescribed to elderly patients with candidaemia and is related with early and late mortality.

Changing epidemiology of candidaemia: Increase in fluconazole‐resistant Candida parapsilosis

“…Candidaemia incidence in hospitalised population can vary greatly depending on geographical reasons, but similar increase overtime was recently described in a single centre in Belgium (1.48/10 000 patient-days) 20 and in regional collection in Lombardy -Italy (1.59/10 000 patient-days). 21 Such an increase in C parapsilosis has been also reported in several other centres worldwide, both in Southern Europe, namely in Italy 21,22 and Spain, 7,23 and in other regions such as in Serbia 24 or South Africa. 25 The increase in C parapsilosis was concomitant to the activation of a PICC team in our hospital and due to the particular tropism of this species for CVC thanks to biofilms production, 26,27 our first clinical suspicion was that the two events were associated.…”

“…Candidaemia incidence in hospitalised population can vary greatly depending on geographical reasons, but similar increase overtime was recently described in a single centre in Belgium (1.48/10 000 patient‐days) and in regional collection in Lombardy ‐ Italy (1.59/10 000 patient‐days) . Such an increase in C parapsilosis has been also reported in several other centres worldwide, both in Southern Europe, namely in Italy and Spain, and in other regions such as in Serbia or South Africa …”

Candidaemia in the elderly: Epidemiology, management and adherence to the European Confederation of Medical Mycology quality indicators

“…In the CANDIPOP study, the mortality in the age group ≥75 years was approximately 42% which was significantly higher when compared to younger patients ( P = .007) 4 . Despite the significant differences in the overall EQUAL scores, we were reassured that the 30‐day survival was similar across age groups in our setting.…”

“…Older people are at greater risk of candidaemia and more susceptible to its effects as a result of age‐related changes in colonisation, higher cumulative use of antibiotics and waning immunity 3 . Data from the CANDIPOP study reveal higher mortality in elderly patients with candidaemia, which was thought to be related to inadequate therapy 4 …”

In Vitro Activity of Isavuconazole against Opportunistic Fungal Pathogens from Two Mycology Reference Laboratories

“…A higher prevalence of IFIs has been observed over the last 3 decades due to the increasing immunocompromised population, which includes individuals living with human immunodeficiency virus, transplant recipients, and cancer patients ( 1 , 3 – 6 ). Additionally, increases in the elderly population, neonates, and patients requiring invasive therapies also contribute to the higher IFI rates ( 4 , 7 , 8 ).…”