High incidence of candidaemia in a nationwide cohort: Underlying diseases, risk factors and mortality

Lausch, Karen Rokkedal; Søgaard, Mette; Rosenvinge, Flemming Schønning; Johansen, Helle Krogh; Boysen, Trine; Røder, Bent; Mortensen, Klaus Leth; Nielsen, Lene; Lemming, Lars; Olesen, Bente; Leitz, Christine; Kristensen, Lise; Dzajic, Esad; Østergaard, Lars; Schønheyder, Henrik Carl; Arendrup, Maiken Cavling

doi:10.1016/j.ijid.2018.08.010

Cited by 23 publications

(33 citation statements)

References 32 publications

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“…The use of echinocandins has increased as an initial therapy for candidaemia during the same period, and it might have decreased the mortality rate. The overall 30‐day mortality rate was similar to figures reported in other Nordic countries: Iceland (30%, 2013), Norway (36%, 2019) and Denmark (37%, 2011 and 43%, 2018) 5,29,31,36 . The 30‐day mortality was 20.0% in PC and 13.9% in non‐PC in our study, but the difference did not reach statistical significance.…”

Section: Discussionsupporting

confidence: 78%

“…The 30‐day mortality was 20.0% in PC and 13.9% in non‐PC in our study, but the difference did not reach statistical significance. Surprisingly, the overall 30‐day mortality rate was lower in PC than overall in our hospital district or in general in candidaemia 2‐5 . Candidaemia is associated with severe underlying comorbidities, for example malignancies 36 .…”

Section: Discussionmentioning

confidence: 68%

“…Candida is a major cause of nosocomial infections, 1 and candidaemia causes significant mortality ranging between 30% and 45% 2‐5 . Furthermore, candidaemia generates significant healthcare costs 2 .…”

Section: Introductionmentioning

confidence: 99%

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Persistent vs non‐persistent candidaemia in adult patients in 2007‐2016: A retrospective cohort study

Ala-Houhala

2020

Mycoses

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Mycoses. 2020;63:617-624. | 617 wileyonlinelibrary.com/journal/myc | INTRODUC TI ONCandida is a major cause of nosocomial infections, 1 and candidaemia causes significant mortality ranging between 30% and 45%. [2][3][4][5] Furthermore, candidaemia generates significant healthcare costs. 2 Its main complications include metastatic infection foci and death. 6 Persistent candidaemia (PC) is frequently recognised as another complication of candidaemia. Underlying factors that can influence the persistence of blood culture positivity in candidaemia Summary Objectives: Persistent candidaemia (PC) is a recognised complication of candidaemia. Our objective was to evaluate risk factors and clinical significance of PC in adult patients.Methods: This is a retrospective, cohort study. We compared PC with non-PC. All patients with blood cultures positive for Candida species were identified from a microbiological database in the hospital district of Helsinki and Uusimaa from 2007 to 2016. PC was defined as an isolation of the same Candida species from positive blood culture for ≥5 days. Results: PC criteria were fulfilled by 75/350 patients (21.4%). No significant difference emerged between persistent and non-persistent cases caused by non-albicans Candida species (37.3% vs 35.1%, P = .742). The length of hospital stay before onset of candidaemia was longer before PC (hospital stay > 7 days; 73.3% vs 59.6%, P = .043).No significant impact on 30-day mortality was observed (20.0% vs 15.5%, P = .422).Using multivariable regression analysis, we found the presence of central venous catheter (CVC) (OR = 2.71, 95% CI 1.31-5.59), metastatic infection foci (OR 3.60, 95% CI 1.66-7.79) and ineffective empirical treatment (OR = 3.31, 95% CI 1.43-7.65) to be independent risk factors for PC. In subgroup analysis, early source control was identified as a protective factor against PC (30.5% vs 57.7%, P = .002). Conclusion:The presence of CVC, metastatic infection foci and ineffective empirical treatment were independently associated with PC in adult patients. Active search for and treatment of metastatic infection foci and removal of CVC are key elements for preventing PC. K E Y W O R D S adult patients, central venous catheter, metastatic infection foci, Persistent candidaemia

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 68%

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Persistent vs non‐persistent candidaemia in adult patients in 2007‐2016: A retrospective cohort study

Ala-Houhala

2020

Mycoses

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“…In the previous studies, mortality rates of approximately 28% have been described, compared with 5% in our cohort . These high mortality rates are often reported in critically ill patients on intensive care units, whereas chronic IF patients tend to be more healthy and live in a relative stable condition at home . Of note, it is unlikely that virulence of certain Candida species played a role, as the distribution of cultured species was similar to other studies …”

Section: Discussionsupporting

confidence: 82%

“…6 These high mortality rates are often reported in critically ill patients on intensive care units, whereas chronic IF patients tend to be more healthy and live in a relative stable condition at home. 23 Of note, it is unlikely that virulence of certain Candida species played a role, as the distribution of cultured species was similar to other studies. 5,8,9 Plantinga et al previously reported in healthy volunteers having 3 TLR1 SNPs a significantly decreased expression of IL-1β, IL-6, and IL-8.…”

Section: Discussionsupporting

confidence: 76%

Contribution of Genetic and Clinical Risk Factors to Development of Candidemia in Patients Receiving Home Parenteral Nutrition

Wouters

Roelofs

Netea

et al. 2019

J Parenter Enteral Nutr

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Background Patients receiving home parenteral nutrition (HPN) have an increased risk for central line–associated bloodstream infections (CLABSIs), including candidemia. Recently, 7 single‐nucleotide polymorphisms (SNPs) in TLR1, CD58, LCE4A‐Clorf68, and TAGAP have been associated with the development of candidemia. Identification of host‐genetic as well as clinical risk factors may help to identify patients who have an increased susceptibility to such infections. The aim of this study was to investigate the relevance of the reported SNPs in patients receiving HPN, and to explore clinical risk factors associated with candidemia. Methods We analyzed blood samples of adult patients who started HPN between 1976 and 2017 at our referral center for intestinal failure. Primary outcome was the association between TLR1, CD58, LCE4A‐Clorf68, or TAGAP SNPs and candidemia. Secondary outcomes included the relation between severity of infection and these SNPs, and clinical risk factors for candidemia. Results Of 341 included patients, 42 (12%) experienced a candidemia (range 1–6). None of the 7 SNPs were associated with candidemia or the severity of infection. The rate of non‐Candida‐related CLABSIs was significantly associated with candidemia (rate ratio, 1.29; 95% CI, 1.14–1.46; P < 0.001). Conclusions None of 7 known SNPs in TLR1, CD58, LCE4A‐Clorf68, or TAGAP were associated with candidemia or severity of infection in patients receiving HPN. The rate of non‐Candida‐related CLABSIs was significantly associated with the development of candidemia. The latter supports the key role of aseptic catheter handling with respect to Candida susceptibility in patients receiving HPN.

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Yeast Engineering for New Antifungal Compounds: A Contextualized Overview

Rodrigues

2020

Fungal Biology

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High incidence of candidaemia in a nationwide cohort: Underlying diseases, risk factors and mortality

Cited by 23 publications

References 32 publications

Persistent vs non‐persistent candidaemia in adult patients in 2007‐2016: A retrospective cohort study

Persistent vs non‐persistent candidaemia in adult patients in 2007‐2016: A retrospective cohort study

Contribution of Genetic and Clinical Risk Factors to Development of Candidemia in Patients Receiving Home Parenteral Nutrition

Yeast Engineering for New Antifungal Compounds: A Contextualized Overview

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