Usefulness of guideline recommendations for prognosis in patients with candidemia

Abstract

We aimed to analyze whether the lack of inclusion of specific recommendations for the management of candidemia is an independent risk factor for early and overall mortality. Multicenter study of adult patients with candidemia in 13 hospitals. We assessed the proportion of patients on whom nine specific ESCMID and IDSA guidelines recommendations had been applied, and analyzed its impact on mortality. 455 episodes of candidemia were documented. Patients who died within the first 48 hours were excluded. Sixty-two percent of patients received an appropriate antifungal treatment. Either echinocandin or amphotericin B therapy were administered in 43% of patients presenting septic shock and in 71% of those with neutropenia. Sixty-one percent of patients with breakthrough candidemia underwent a change in antifungal drug class. Venous catheters were removed in 79% of cases. Follow-up blood cultures were performed in 72% of cases. Ophthalmoscopy and echocardiogram were performed in 48% and 50% of patients, respectively. Length of treatment was appropriate in 78% of cases. Early (2–7 days) and overall (2–30 days) mortality were 8% and 27.7%, respectively. Inclusion of less than 50% of the specific recommendations was independently associated with a higher early (HR = 7.02, 95% CI: 2.97–16.57; P < .001) and overall mortality (HR = 3.55, 95% CI: 2.24–5.64; P < .001). In conclusion, ESCMID and IDSA guideline recommendations were not performed on a significant number of patients. Lack of inclusion of these recommendations proved to be an independent risk factor for early and overall mortality.

The Overlooked Immune State in Candidemia: A Risk Factor for Mortality

“…Garnacho-Monterio et al, Kato et al, and Papadimitriou-Olivgeris et al identified that appropriate empirical antifungal treatment was related to better prognosis [12,39,40]. Indeed, lack of inclusion of European Society of Clinical Microbiology and Infectious Disease (ESCMID) and Infectious Diseases Society of America (IDSA) guideline recommendations was an independent risk factor for a higher early and overall mortality [4]. In the same way, Keighley et al found that age > 65 years, ICU admission, chronic organ dysfunction, preceding surgery within 30 days, haematological malignancy, source of candidaemia, and antibiotic therapy for ≥10 days were independent risk factors for candidemia mortality, which served to develop a risk predictive score [41].…”

“…This infection is associated with considerable morbidity and mortality, including prolonged hospital stays and increased healthcare costs, with 30% to 50% occurring in patients in the intensive care unit (ICU) [3]. Importantly, the crude candidemia mortality ranges from approximately 22% to 75%, despite advances in diagnosis and therapy [4,5,6,7,8]. Despite advancements such as effective broad-spectrum antifungals and recent management guidelines, the incidence of candidemia has doubled over the past two decades [7,9].…”

Factors associated with the development of septic shock in patients with candidemia: a post hoc analysis from two prospective cohorts

“…The incidence of septic shock is only collaterally mentioned in reports on candidemia in the general populations and it ranges from 12.9 to 49.0% in recent studies [16][17][18]. However, only three series have specifically focused on the incidence of septic shock among candidemic patients.…”

“…16 Microbiology Unit, Azienda Sanitaria Universitaria Integrata Santa Maria della Misericordia, Udine, Italy. 17 Medicine Department School of Medicine, Universidad Complutense de Madrid, Madrid, Spain. 18 CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Udine, Spain.…”

Importancia del estado inmune y recuento linfocitario como factor de riesgo de mortalidad en pacientes con candidemia

“…Recomendaciones y grados de evidencia de las técnicas alternativas al cultivo para el diagnóstico de candidemia morbimortalidad de la candidemia, es muy elevada, pudiendo llegar a tener una tasa de mortalidad mayor de 40% en pacientes en UCI. Un retraso en el inicio del tratamiento se ha relacionado con un incremento de la mortalidad a los 30 y 90 días del diagnóstico(17,42,53,107,131, 132). Un diagnóstico precoz resulta difícil dado que las técnicas diagnósticas que existen en la mayoría de los hospitales requieren tiempo y su valor predictivo positivo es bajo.…”