Candidemia in a Tertiary Care Hospital: Epidemiology, Risk Factors, and Predictors of Mortality

Abstract

Demographic information, risk factors, therapy, and outcome for all patients who had candidemia at Barnes Hospital, St. Louis, between 1 September 1988 and 1 September 1989 were retrospectively reviewed. One hundred six candidemic patients were identified, representing 0.5% of all medical and surgical discharges and 0.33% of total patient discharges. These percentages represent a 20-fold increase in the incidence of candidemia at our hospital in comparison with that during 1976-1979. Candida albicans was the most frequently isolated species (63%), followed by Candida tropicalis (17%), Candida glabrata (13%), Candida parapsilosis (6.5%), and Candida krusei (0.9%). Overall mortality was 57%, and 14 (23%) of 60 deaths occurred within 48 hours of the detection of candidemia. Mortality was associated with higher APACHE II scores (25 for nonsurvivors vs. 16 for survivors; P = .0001), the presence of a rapidly fatal underlying illness (P = .0009), and sustained positivity of blood cultures (P = .02). In cases of sustained candidemia, the isolation of non-albicans Candida species also correlated with increased mortality (8 of 8 vs. 10 of 21; P = .005). Thirty candidemic patients (28%) did not receive any antifungal therapy, and 19 (63%) of these untreated patients died. Eleven untreated patients (37%) survived without sequelae. There has been a marked increase in the incidence of candidemia in our institution that is associated with a high overall mortality. Candidemia lasting less than 24 hours was associated with a lower mortality than was that of longer duration. Severity of illness and duration of candidemia should be used as stratifying factors in prospective studies to determine optimum therapy.

Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part II. Treatment

“…Catheter management in the ICU patient It has been known for a long time that intravascular catheters are significant risk factors for the development of candidemia [37,38]. The initial retrospective study by Rex et al [39] suggested the need to remove all intravascular catheters in candidemia.…”

Systemic fungal infection is associated with the development of retinopathy of prematurity in very low birth weight infants: a meta-review

“…[5][6][7] Neonatal candidemia occurs in 1.6 to 9% of VLBW infants 1,2 and 4 to 15% in extremely low birth weight infants (ELBW; birth weight <1000 g), with the 30-day mortality approaching 40%. 1,4,[8][9][10][11] The occurrence of candidemia has been reported as an independent risk factor associated with development of retinopathy of prematurity (ROP) [12][13][14][15][16][17] and ROP requiring laser surgery. 12 Yet others 18 have found such an association only in a univariate analysis but not in a multiple logistic regression model.…”

Detection of Fungemia by Polymerase Chain Reaction in Critically Ill Neonates and Children

“…2,10 In one study, patients with candidemia of more than 2 days' duration prior to initiation of antifungal therapy had a two-fold higher mortality than those who were treated more promptly. 11 Early removal of central venous catheters in neonates and children with candidemia is also associated with significantly decreased mortality and morbidity. [12][13] Early and reliable detection of disseminated Candida infection is crucial yet problematic.…”

“…Blood culture detection of candidemia may take 48 hours or more, and some cases of systemic candidiasis are not diagnosed until autopsy. 1,11,14 As a result of these impediments to detection of Candida sepsis and the high morbidity and mortality associated with delayed treatment, NICU and PICU patients are often treated empirically with antifungal agents, with attendant risks of toxicity and emergence of drug resistance.…”