Abstract
BackgroundDelayed antifungal therapy for candidemia leads to increased mortality. Differentiating bacterial infection from candidemia in systemic inflammatory response syndrome (SIRS) patients is complex and difficult. The Delta Neutrophil Index (DNI) has recently been considered a new factor to distinguish infections from non-infections and predict the severity of sepsis. We aimed to assess if the DNI can predict and provide a prognosis for candidemia in SIRS patients.MethodsA matched case-control study was conducted from July 2016 to June 2017 at Kangdong Sacred Heart Hospital. Among patients with a comorbidity of SIRS, those with candidemia were classified as the case group, whereas those with negative blood culture results were classified as the control group. The matching conditions included age, blood culture date, and SIRS onset location. Multivariate logistic regression was performed to evaluate DNI as a predictive and prognostic factor for candidemia.ResultsThe 140 included patients were assigned to each group in a 1:1 ratio. The DNI_D1 values measured on the blood culture date were higher in the case group than in the control group (p < 0.001). The results of multivariate analyses confirmed DNI_D1 (odds ratio [ORs] 2.138, 95% confidential interval [CI] 1.421–3.217, p < 0.001) and Candida colonization as predictive factors for candidemia. The cutoff value of DNI for predicting candidemia was 2.75%. The area under the curve for the DNI value was 0.804 (95% CI, 0.719–0.890, p < 0.001), with a sensitivity and specificity of 72.9 and 78.6%, respectively. Analysis of 14-day mortality in patients with candidemia showed significantly higher DNI_D1 and DNI_48 in the non-survivor group than in the survivor group.ConclusionsDNI was identified as a predictive factor for candidemia in patients with SIRS and a prognostic factor in predicting 14-day mortality in candidemia patients. DNI, along with clinical patient characteristics, was useful in determining the occurrence of candidemia in patients with SIRS.
Highlights
Delayed antifungal therapy for candidemia leads to increased mortality
Case and control patients were matched at a 1:1 ratio using the following matching criteria: 1) blood culture procedure dates within ±3 days, 2) age ± 3 years, and 3) same patient location at systemic inflammatory response syndrome (SIRS) onset (ICU vs. general ward)
There was no significant difference in patient locations at the time of SIRS occurrence between the case and control groups
Summary
Delayed antifungal therapy for candidemia leads to increased mortality. Differentiating bacterial infection from candidemia in systemic inflammatory response syndrome (SIRS) patients is complex and difficult. We aimed to assess if the DNI can predict and provide a prognosis for candidemia in SIRS patients. The number of candidemia cases has gradually been increasing due to the development of immunosuppressive treatments and invasive procedures. The primary factor in reducing candidemia-induced mortality rates is the early administration of appropriate antifungal therapy (AAT) [2]. Various markers and testing methods have been developed to predict candidemia to enable early-stage antifungal therapy [3,4,5]. There are cases in which these testing methods cannot be applied in actual treatment or are difficult to be commonly used
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