The Predictors of Outcome in Immunocompetent Patients With Hematogenous Candidiasis

Int J Infect Dis. 2004 May;8(3):180-6. doi: 10.1016/j.ijid.2003.05.003.

Abstract

Objective: Clinical parameters that predict outcome in non-immunosuppressed candidemic patients are not fully understood.

Methods: Eighty-one consecutive episodes of candidemia were retrospectively evaluated in 75 patients during 1998-2000.

Results: Infection due to Candida albicans was common (n = 30; 37%) followed by Candida glabrata (n = 25; 31%), Candida parapsilosis (n = 14; 17%), Candida tropicalis (n = 6; 7%), Candida krusei (n = 5; 6%), and Candida lusitaniae (n = 1; 1%). Among 70 evaluable patients, 31 (44%) had fungemia-associated mortality; advanced age (P < 0.004), underlying malignancy (P < 0.025), coronary artery disease (P < 0.01), and concurrent non-Candida species fungal infection (P < 0.047) were significant prognosticators of compromised short-term survival by multivariate analysis. Mortality was higher in patients with Candida glabrata (60%) and C. tropicalis (75%) infection compared to 44% deaths in individuals with C. albicans infection (P > 0.1). 11/25 (44%) of non-immunocompromised individuals died and 20/45 (44%) immunosuppressed patients succumbed to fungemia: persistent vs. non-persistent (< 3 days) Candida bloodstream invasion, neutropenia, diabetes mellitus, renal insufficiency, prior antimicrobial therapy, cirrhosis of liver, abdomino-pelvis surgery, and critical-care-unit vs. non critical-care-unit admission did not significantly impact outcome in either group. All 11 infants, including nine with prematurity, survived Candida species bloodstream infection (P < 0.025).

Conclusions: Short-term mortality in candidemic non-immunocompromised patients was comparable to fungemia-associated deaths in immunosuppressed patients. Ischemic heart disease has appeared as a new predictor of unfavorable outcome in patients with hematogenous candidiasis.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Blood / microbiology
  • Candida / classification
  • Candida / isolation & purification*
  • Candida albicans / isolation & purification
  • Candidiasis / microbiology
  • Candidiasis / mortality*
  • Child
  • Child, Preschool
  • Culture Media
  • Female
  • Fungemia / microbiology
  • Fungemia / mortality*
  • Humans
  • Immunocompetence*
  • Immunocompromised Host
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Myocardial Ischemia / complications
  • Predictive Value of Tests

Substances

  • Culture Media