Risk factors associated with mortality among patients who had candidemia in a university hospital

Alves, Priscila Guerino Vilela; Melo, Sávia Gonçalves Oliveira; Bessa, Meliza Arantes de Souza; Brito, Murilo de Oliveira; Menezes, Ralciane de Paula; Araújo, Lúcio Borges de; Penatti, Mário Paulo Amante; Pedroso, Reginaldo dos Santos; Röder, Denise Von Dolingër de Brito

doi:10.1590/0037-8682-0206-2019

Cited by 12 publications

(6 citation statements)

References 17 publications

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“…Numerous parameters have been identified as risk factors for mortality after candidemia in critically ill patients. These include a history of congestive heart failure, the presence of solid tumors with metastases, red blood cell transfusions, and the duration of antifungal treatment [ 24 , 43 – 45 ]. For survival analysis, we selected covariates that were considered clinically relevant or factors that had been associated with 30-day mortality in a multinational observational study in 23 European ICUs [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis

Schroeder

Weber

Denker

et al. 2020

Ann. Intensive Care

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Background Despite advances in the management of bloodstream infections (BSI) caused by Candida spp., the mortality still remains high in critically ill patients. The worldwide epidemiology of yeast-related BSI is subject to changing species distribution and resistance patterns, challenging antifungal treatment strategies. The aim of this single-center study was to identify predictors of mortality after 28 and 180 days in a cohort of mixed surgical and medical critically ill patients with candidemia. Methods Patients, who had been treated for laboratory-confirmed BSI caused by Candida spp. in one of 12 intensive care units (ICU) at a University hospital between 2008 and 2017, were retrospectively identified. We retrieved data including clinical characteristics, Candida species distribution, and antifungal management from electronic health records to identify risk factors for mortality at 28 and 180 days using a Cox regression model. Results A total of 391 patients had blood cultures positive for Candida spp. (incidence 4.8/1000 ICU admissions). The mortality rate after 28 days was 47% (n = 185) and increased to 60% (n = 234) after 180 days. Age (HR 1.02 [95% CI 1.01–1.03]), a history of liver cirrhosis (HR 1.54 [95% CI 1.07–2.20]), septic shock (HR 2.41 [95% CI 1.73–3.37]), the Sepsis-related Organ Failure Assessment score (HR 1.12 [95% CI 1.07–1.17]), Candida score (HR 1.25 [95% CI 1.11–1.40]), and the length of ICU stay at culture positivity (HR 1.01 [95% CI 1.00–1.01]) were significant risk factors for death at 180 days. Patients, who had abdominal surgery (HR 0.66 [95% CI 0.48–0.91]) and patients, who received adequate (HR 0.36 [95% CI 0.24–0.52]) or non-adequate (HR 0.31 [95% CI 0.16–0.62]) antifungal treatment, had a reduced mortality risk compared to medical admission and no antifungal treatment, respectively. Conclusions The mortality of critically ill patients with Candida BSI is high and is mainly determined by disease severity, multiorgan dysfunction, and antifungal management rather than species distribution and susceptibility. Our results underline the importance of timely treatment of candidemia. However, controversies remain on the optimal definition of adequate antifungal management.

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Section: Discussionmentioning

confidence: 99%

Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis

Schroeder

Weber

Denker

et al. 2020

Ann. Intensive Care

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“…Studies have shown that this infection can have varying mortality rates, from 12% to 70% (Bassetti, et al, 2019) (Medeiros, et al, 2019) (Pappas, et al, 2018) (Tsay, et al, 2020), which reflects the severity of cases of this disease. Studies have indicated high mortality rates in Brazil due to candidemia, from 43% to 72.2% (Alves, et al, 2020) (Doi, et al, 2016) (Khouri, et al, 2016). It is important to note that 26% (17/63) of the patients who died in the present study did not receive antifungal treatment, since the death occurred before the infection diagnosis.…”

Section: Amphotericinmentioning

confidence: 65%

Characterization of Candida spp. isolated from the bloodstream in a reference hospital in Brazil: using MALDI-TOF/MS to identify unusual species of Candida

Aguiar

Menezes

Penatti

et al. 2022

RSD

Self Cite

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Candidemia is a health problem with a high mortality rate. The aims of this study were to compare the identification of Candida spp. via traditional methodologies and mass spectrometry (MALDI-TOF/MS) in order to verify the antifungal susceptibility profile of these isolates and analyze the clinical evolution of patients. This was a two-year prospective cohort conducted at the Hospital de Clínicas de Uberlândia (HCU-UFU). Candida spp. were identified via VITEK®-2 and MALDI-TOF/MS. Antifungal susceptibility tests were conducted via VITEK®-2. Clinical-demographic data were assessed from medical records and variables were described as mean, standard deviation, frequency and percentage, and risk factors were evaluated using univariate and multivariate analysis. A total of 113 patients and 126 Candida spp. isolates were studied. C. albicans was most frequent (30%); MALDI-TOF/MS identified unusual species, including misidentification of C. famata. Most of the isolates (95%) were susceptible to the tested antifungals. Most patients were men (65%) and older than 60 years of age (45%); 85% of patients were treated with fluconazole. The 30-day mortality rate was 56%; patients who did not receive treatment and those who started later had a lower survival rate (p <0.0001). MALDI-TOF/MS was able to identify unusual Candida spp. Candidemia presented a high mortality rate; the correct identification of Candida spp. and the introduction of appropriate and timely therapy are essential for increasing patient survival.

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“…Since these associations were not confirmed with the multivariate regression analysis, they could be just epiphenomena. In other studies with patients with candidemia, higher age was associated with higher mortality, among other factors [ 80 ]. Importantly, the removal of CVC in patients with W. anomalus fungemia in the current review was associated with reduced mortality.…”

Section: Discussionmentioning

confidence: 94%

Fungemia by Wickerhamomyces anomalus—A Narrative Review

Ioannou,

Baliou,

Kofteridis

2024

Pathogens

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Wickerhamomyces anomalus has been previously classified as Hansenula anomala, Pichia anomala, and Candida pelliculosa and was recently reclassified in the genus Wickerhamomyces after phylogenetic analysis of its genetic sequence. An increasing number of reports of human infections by W. anomalus have emerged, suggesting that this microorganism is an emerging pathogen. The present review aimed to provide data on the epidemiology, antifungal resistance, clinical characteristics, treatment, and outcomes of fungemia by W. anomalus by extracting all the available information from published original reports in the literature. PubMed/Medline, Cochrane Library, and Scopus databases were searched for eligible articles reporting data on patients with this disease. In total, 36 studies involving 170 patients were included. The age of patients with fungemia by W. anomalus ranged from 0 to 89 years; the mean age was 22.8 years, the median age was 2.2 years, with more than 37 patients being less than one month old, and 54% (88 out of 163 patients) were male. Regarding patients’ history, 70.4% had a central venous catheter use (CVC), 28.7% were on total parenteral nutrition (TPN), 97% of neonates were hospitalized in the neonatal ICU (NICU), and 39.4% of the rest of the patients were hospitalized in the intensive care unit (ICU). Previous antimicrobial use was noted in 65.9% of patients. The most common identification method was the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) in 34.1%, VITEK and VITEK 2 in 20.6%, and ID32 C in 15.3%. W. anomalus had minimal antifungal resistance to fluconazole, echinocandins, and amphotericin B, the most commonly used antifungals for treatment. Fever and sepsis were the most common clinical presentation noted in 95.8% and 86%, respectively. Overall mortality was 20% and was slightly higher in patients older than one year. Due to the rarity of this disease, future multicenter studies should be performed to adequately characterize patients’ characteristics, treatment, and outcomes, which will increase our understanding and allow drawing safer conclusions regarding optimal management.

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Risk factors associated with mortality among patients who had candidemia in a university hospital

Cited by 12 publications

References 17 publications

Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis

Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis

Characterization of Candida spp. isolated from the bloodstream in a reference hospital in Brazil: using MALDI-TOF/MS to identify unusual species of Candida

Fungemia by Wickerhamomyces anomalus—A Narrative Review

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