Candidaemia and a risk predictive model for overall mortality: a prospective multicentre study

Abstract

Background Candidaemia is associated with high mortality. Variables associated with mortality have been published previously, but not developed into a risk predictive model for mortality. We sought to describe the current epidemiology of candidaemia in Australia, analyse predictors of 30-day all-cause mortality, and develop and validate a mortality risk predictive model. Methods Adults with candidaemia were studied prospectively over 12 months at eight institutions. Clinical and laboratory variables at time of blood culture-positivity were subject to multivariate analysis for association with 30-day all-cause mortality. A predictive score for mortality was examined by area under receiver operator characteristic curves and a historical data set was used for validation. Results The median age of 133 patients with candidaemia was 62 years; 76 (57%) were male and 57 (43%) were female. Co-morbidities included underlying haematologic malignancy ( n = 20; 15%), and solid organ malignancy in ( n = 25; 19%); 55 (41%) were in an intensive care unit (ICU). Non- albicans Candida spp . accounted for 61% of cases (81/133). All-cause 30-day mortality was 31%. A gastrointestinal or unknown source was associated with higher overall mortality than an intravascular or urologic source ( p < 0.01). A risk predictive score based on age > 65 years, ICU admission, chronic organ dysfunction, preceding surgery within 30 days, haematological malignancy, source of candidaemia and antibiotic therapy for ≥10 days stratified patients into < 20% or ≥ 20% predicted mortality. The model retained accuracy when validated against a historical dataset ( n = 741). Conclusions Mortality in patients with candidaemia remains high. A simple mortality risk predictive score stratifying patients with candidaemia into < 20% and ≥ 20% 30-day mortality is presented. This model uses information available at time of candidaemia diagnosis is easy to incorporate into decision support systems. Further validation of this model is warranted. Electronic supplementary material The online version of this article (10.1186/s12879-019-4065-5) contains supplementary material, which is available to authorized users.

A seven-year surveillance study of the epidemiology, antifungal susceptibility, risk factors and mortality of candidaemia among paediatric and adult inpatients in a tertiary teaching hospital in China

“…Our data showed that the median age of patients with candidaemia and the proportion of males were similar to those in other studies [8,[18][19][20][21][22][23]. Moreover, our study showed that the patients with candidaemia were hospitalised mostly in internal medicine wards, which is different from other studies that reporting hospitalisation mainly in ICU wards [8,22,[24][25][26][27], but similar to other studies [28][29][30][31].…”

A seven-year surveillance study of the epidemiology, antifungal susceptibility, risk factors and mortality of candidaemia among paediatric and adult inpaitents in a tertiary teaching hospital in China

“…The change trend was similar to that reported by Oeser et al [38]. The overall morbidity and 30-day mortality in ICUs and hospitals in this study were similar to those in another hospital in this region of China [18], but lower than those in hospitals in other regions of China [35,37] and other countries [5,8,16,20,21,23,25,30]. The overall mortality rate of candidaemia has been reported to be 20%-49% globally [39], and the mortality rate was 20.4% in our hospital, which is low compared to the global rate.…”

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

“…Candidaemia in the healthcare setting is associated with high mortality 1 . In particular, the outcome is poor in certain vulnerable populations which includes the elderly and the neonates as well as patients with co‐morbidities such as haematological malignancies, organ dysfunction and prior surgery 2 . Although the epidemiology of candidaemia has been extensively investigated, the effects of candidaemia in the elderly population have not received adequate level of attention.…”