Mortality in patients with early- or late-onset candidaemia.

Abstract

OBJECTIVES:

Although candidaemia is a well-known complication of hospital stay and has a crude mortality of ∼40%, few data are available for episodes diagnosed within 10 days after hospital admission. In this paper, we compared the risk factors for mortality according to the onset of candidaemia.

METHODS:

This was a retrospective study of hospitalized patients with early-onset candidaemia (EOC; ≤ 10 days) or late-onset candidaemia (LOC; >10 days) to identify any distinct clinical characteristics and risk factors for 30 day mortality in two Italian academic centres.

RESULTS:

A total of 779 patients were included in the study: 183 EOC and 596 LOC. Mortality was significantly lower in EOC (71/183, 38.8% versus 283/596, 47.5%, P=0.03). In EOC, multivariate analysis showed that inadequate initial antifungal therapy (IIAT) (P=0.005, OR 3.02, 95% CI 1.40-6.51), Candida albicans aetiology (P=0.02, OR 2.17, 95% CI 1.11-4.26) and older age (P<0.001, OR 1.05, 95% CI 1.02-1.07) were independent risk factors for mortality. In LOC, liver disease (P=0.003, OR 2.46, 95% CI 1.36-4.43), IIAT (P=0.002, OR 2.01, 95% CI 1.28-3.15) and older age (P<0.001, OR 1.03, 95% CI 1.02-1.04) were independently associated with a fatal outcome, while treatment with caspofungin was associated with survival (P<0.001, OR 0.42, 95% CI 0.26-0.67).

CONCLUSIONS:

EOC has different clinical characteristics and risk factors for mortality compared with LOC. Although EOC mortality is significantly lower, the rate of inappropriate antifungal treatment is higher. Treatment with caspofungin is significantly associated with survival in patients with LOC. Efforts are needed to improve the diagnosis and treatment of EOC.

• Authors: Francesco Giuseppe De Rosa, Enrico Maria Trecarichi, Chiara Montrucchio, Angela Raffaella Losito, Stefania Raviolo, Brunella Posteraro, Silvia Corcione, Simona Di Giambenedetto, Lucina Fossati, Maurizio Sanguinetti, Roberto Serra, Roberto Cauda, Giovanni Di Perri, Mario Tumbarello
• Journal: The Journal of antimicrobial chemotherapy (J Antimicrob Chemother) Vol. 68 Issue 4 Pg. 927-35 (Apr 2013) ISSN: 1460-2091 [Electronic] England
• PMID: 23236102 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Academic Medical Centers
• Aged
• Candidemia (diagnosis, mortality, pathology)
• Cross Infection (diagnosis, mortality, pathology)
• Female
• Humans
• Italy (epidemiology)
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors