Characteristics of candidaemia with Candida-albicans compared with non-albicans Candida species and predictors of mortality

Weinberger, Miriam; Leibovici, Leonard; Pérez, S. Cano; Samra, Zmira; Ostfeld, Iris; Levi, Itzhak; Bash, Edna; Turner, Dan; Goldschmied-Reouven, Anna; Regev‐Yochay, Gili; Pitlik, Silvio; Keller, Nathan

doi:10.1016/j.jhin.2005.02.009

Cited by 79 publications

(74 citation statements)

References 55 publications

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“…Diabetes mellitus [20], liver cirrhosis [25,27], malignancy [32], and hypoalbuminemia (albumin \ 3.0 g/dL) [33] have been shown to lead to higher infection rates in joint arthroplasty. Meanwhile, renal function, nutritional status, and pulmonary function are known to be important in the host's ability to respond to the treatment of musculoskeletal infection [22,26].…”

Section: Resultsmentioning

confidence: 99%

What Is the Success of Treatment of Hip and Knee Candidal Periprosthetic Joint Infection?

Ueng

Lee

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Fungal infection at an arthroplasty site is rare and poses a therapeutic challenge. To the best of our knowledge, no reports have been published thus far on the success rate of prosthesis reimplantation after fungal prosthetic joint infections. Questions/purposes We asked: (1) What is the success rate in terms of infection eradication using a two-stage exchange arthroplasty in patients with hip or knee fungal periprosthetic joint infections, particularly focusing on Candida infections? (2) What patient-, infection-, and treatment-related variables are associated with the success or failure of treatment? Methods From January 2000 to December 2010, 16 patients with hip or knee candidal periprosthetic joint infections were treated with two-stage exchange arthroplasty at our institute. Treatment success was defined as a well-functioning joint without relapse of candidal infection after prosthesis reimplantation, while treatment failure was defined as uncontrolled or relapse of candidal infection or mortality. Variables, including age, sex, comorbidities, microbiology, antimicrobial agents used, and operative methods, were analyzed. Minimum followup was 28 months (mean, 41 months; range, 28-90 months). Results At latest followup, the treatment failed to eradicate the infection in eight of the 16 patients, and there were four deaths related to fungemia. Four patients required permanent resection arthroplasty owing to uncontrolled or recurrent candidal infections. All eight patients (50% successful rate) who had their infections eradicated and successful prosthesis reimplantation had prolonged treatment with oral fluconazole before (mean, 8 months) and after (mean, 2.2 months) prosthesis reimplantation. The antifungal therapy correlated with successful treatment. Renal insufficiency, hypoalbuminemia, anemia, and chronic obstructive pulmonary disease were significantly more prevalent in the treatmentfailure group than in the treatment-success group.

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Section: Resultsmentioning

confidence: 99%

What Is the Success of Treatment of Hip and Knee Candidal Periprosthetic Joint Infection?

Ueng

Lee

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…C. parapsilosis is lowly virulent and, in general, associated with a higher survival rate (6). Thus, not only would fewer patients have received suboptimal treatment, but these cases might also have been less grave (3,6,20,23,38,54,55).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Issues, Clinical Characteristics, and Outcomes for Patients with Fungemia

et al. 2011

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This study investigated microbiological, clinical, and management issues and outcomes for Danish fungemia patients. Isolates and clinical information were collected at six centers. A total of 334 isolates, 316 episodes, and 305 patients were included, corresponding to 2/3 of the national episodes. Blood culture positivity varied by system, species, and procedure. Thus, cases with concomitant bacteremia were reported less commonly by BacT/Alert than by the Bactec system (9% [11/124 cases] versus 28% [53/192 cases]; P < 0.0001), and cultures with Candida glabrata or those drawn via arterial lines needed longer incubation. Species distribution varied by age, prior antifungal treatment (57% occurrence of C. glabrata, Saccharomyces cerevisiae, or C. krusei in patients with prior antifungal treatment versus 28% occurrence in those without it; P ‫؍‬ 0.007), and clinical specialty (61% occurrence of C. glabrata or C. krusei in hematology wards versus 27% occurrence in other wards; P ‫؍‬ 0.002). Colonization samples were not predictive for the invasive species in 11/100 cases. Fifty-six percent of the patients had undergone surgery, 51% were intensive care unit (ICU) patients, and 33% had malignant disease. Mortality increased by age (P ‫؍‬ 0.009) and varied by species (36% for C. krusei, 25% for C. parapsilosis, and 14% for other Candida species), severity of underlying disease (47% for ICU patients versus 24% for others; P ‫؍‬ 0.0001), and choice but not timing of initial therapy (12% versus 48% for patients with C. glabrata infection receiving caspofungin versus fluconazole; P ‫؍‬ 0.023). The initial antifungal agent was deemed suboptimal upon species identification in 15% of the cases, which would have been 6.5% if current guidelines had been followed. A large proportion of Danish fungemia patients were severely ill and received suboptimal initial antifungal treatment. Optimization of diagnosis and therapy is possible. Surveillance of fungemia was initiated in Denmark in 2003and has demonstrated a high incidence of this condition and an increasing proportion of isolates belonging to the not fully susceptible species Candida glabrata and C. krusei from a Nordic as well as a global perspective (4, 9-11, 16, 23, 27, 40, 41, 46, 52).A number of recent surveys have provided important information on underlying diseases and host factors in patients with fungemia. The most important factors are (i) critical illness with a prolonged stay in the intensive care unit (ICU); (ii) abdominal surgery, especially if it is complicated or repeated; (iii) low birth weight; (iv) acute necrotizing pancreatitis; (v) malignant disease; (vi) organ transplantation, especially of the liver; (vii) Candida colonization; and (viii) use of antibiotics, central venous catheters, steroids, dialysis, and total parenteral nutrition.The crude 30-day mortality was 30 to 40% in most population-based studies enrolling patients until the turn of the millennium (2,4,12,14,16,29,41,42,49,52) but was lower in recent studies (16,17,36) and higher for ICU pati...

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“…Independent risk factors associated with mortality in patients with candidemia have been reported in various studies [14][15][16][17][18] . Included in the risk factors are advanced age and high scores of the Acute Physiology and Chronic Health Evaluation (APACHE) II [14] , or bacterial sepsis, rapidly fatal illness, chronic obstructive lung disease, presence of a central venous catheter and lack of antifungal therapy [15] ; impaired general condition performance status, low serum albumin, congestive heart failure and shock were independent factors associated with mortality.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Etiology and Risk Factors Associated with Mortality of Nosocomial Candidemia in a Tertiary Care Hospital in Istanbul, Turkey

Erdem¹,

Oguzoglu²,

Engin³

et al. 2010

Med Princ Pract

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Objective: The aim of this study was to determine the incidence, etiology and risk factors for mortality of patients with nosocomial candidemia. Subjects and Methods: This observational study was performed at Haydarpasa Numune Training and Research Hospital, a tertiary care hospital with 750 beds, between the years 2004 and 2007. Fifty defined cases with a nosocomial bloodstream infection caused by Candida species were included in the study. All demographic, microbiological and clinical records for each patient were collected using a standardized form. Blood culture was performed by automated blood culture system, and those samples positive for yeast were subcultured on Sabouraud agar. Results: The mean incidence density of nosocomial candidemia was 0.58/10,000 patient-days/year (range 0.17–1.4). Candidemia episodes increased from 0.17/10,000 to 1.4/10,000 patient-days/year (p < 0.0001). Candida albicans and non-albicans Candida accounted for 15 (30%) and 35 (70%) cases, respectively. The overall mortality was 56% and was significantly associated with stayingin the intensive care unit (odds ratio: 3.667, 95% confidence interval: 1.07–12.54, p = 0.034). Conclusion: This study showed that there was a significantly increased trend in the incidence of candidemia with high mortality during the study period.

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Characteristics of candidaemia with Candida-albicans compared with non-albicans Candida species and predictors of mortality

Cited by 79 publications

References 55 publications

What Is the Success of Treatment of Hip and Knee Candidal Periprosthetic Joint Infection?

What Is the Success of Treatment of Hip and Knee Candidal Periprosthetic Joint Infection?

Diagnostic Issues, Clinical Characteristics, and Outcomes for Patients with Fungemia

Incidence, Etiology and Risk Factors Associated with Mortality of Nosocomial Candidemia in a Tertiary Care Hospital in Istanbul, Turkey

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