Analysis of clinical characteristics and risk factors associated with prognosis of patients with candidemia

Abstract

To explore the microbiological and clinical characteristics of patients with candidemia and analyze their prognostic risk factors. A retrospective analysis was conducted for hospitalized patients with candidemia from January 2008 to December 2012 at Affiliated Zhongshan Hospital, Fudan University. Pathogen spectrum, resistance pattern, underlying diseases, therapy received and patient prognosis were collected by chart review. The univariate and multivariate Logistic regression analyses were used to determine the prognostic risk factors of candidemia. A total of 138 inpatients were identified. There were 98 males and 40 females with a mean age of (61.3 ± 16.6) years. The morbidity rate of candidemia in annual discharged patients was 0.034%-0.051%. The most common pathogens were Candida albicans (n = 72, 52.2%), Candida parapsilosis (n = 29, 21.0%) and Candida tropicalis (n = 16, 11.6%). The antibiotic susceptible rate of azole for Candida was 90.9%-97.4% while 55.6%-83.3% for Candida tropicalis. The overall case fatality rate of candidemia was 39.1% (54/138) while the attributable case fatality rate 31.9% (44/138). Multivariate Logistic regression analysis indicated acute physiology and chronic health evaluation II(APACHE II) score ≥ 20 points (OR = 8.025, 95%CI: 2.032-31.696, P = 0.003), hypoproteinemia (OR = 6.213, 95%CI: 1.849-20.879, P = 0.003), concurrent bacteremia (OR = 5.541, 95%CI: 1.576-19.487, P = 0.008) and indwelling urethral catheter (OR = 13.776, 95%CI: 1.402-135.352, P = 0.024) were the independent risk factors of candidemia-related mortality, while removal or replacement of central venous catheter (OR = 0.231, 59%CI: 0.075-0.716, P = 0.011) and surgery within 30 days (OR = 0.206, 95%CI: 0.050-0.857, P = 0.030) were the protective factors. Candida albicans is the most common causative agent. The case fatality rate of candidemia has remained high. APACHE II score ≥ 20 points, hypoproteinemia, indwelling urethral catheter and concurrent bacteremia are independent risk factors attributing to candidemia-related mortality while removal or replacement of central venous catheter and surgery within 30 days are the protective ones.