Abstract
BackgroundCandidemia is the worldwide life-threaten disease, especially in cancer patients. This study was aimed to identify and evaluate the risk factors of candidemia in cancer patients, which will prompt the improvement on current therapeutic strategies and prognosis.MethodsA retrospective, case-control study was conducted from inpatients of Tianjin Medical University Cancer Institute and Hospital, during 2006 to 2013. Analyses were performed between cancer patients with candidemia as study case, and patients with bacterial bloodstream infections as control. Each case was matched up with two controls, for gender and inpatient duration. Candida species, clinical characteristics, risk factors and outcomes were reviewed in details.ResultsTotal number of 80 cases and 160 controls were enrolled and analyzed in this study. Candida albicans was identified as the most prevalent species and account for 55.0% candidemia, followed by Candida parapsilosis complex (21.3%), Candida tropicalis (8.8%), Candida glabrata complex (7.5%), Candida lusitaniae (3.8%), and Candida famata (3.8%). The crude mortality at 30-days of candidemia was up to 30.0%, which is significantly higher than bacterial bloodstream infections (p = 0.006). Logistical analysis demonstrated that total parenteral nutrition >5 days (p = 0.036), urinary catheter >2 days (p = 0.001), distant organ metastasis of cancer (p = 0.002) and gastrointestinal cancer (p = 0.042) were the independent risk factors for candidemia.ConclusionsCandidemia showed significant higher mortality than bacterial bloodstream infections, C. albicans was cited as the primary pathogen. Total parenteral nutrition, urinary catheter, distant organ metastasis of cancer and gastrointestinal cancer are independent predictors for candidemia, this findings provides potential therapeutic targets for improving the outcome.
Highlights
Candidemia is the worldwide life-threaten disease, especially in cancer patients
160 bacteria strains were isolated from 160 patients with bacterial bloodstream infections
Logistical analysis indicated that total parenteral nutrition >5 days (OR = 2.515, 95% CI = 1.060–5.966, p = 0.036), urinary catheter >2 days (OR = 5.105, 95% CI = 1.913–13.626, p = 0.001), distant organ metastasis of cancer (OR = 3.610, 95% CI = 1.578–8.263, p = 0.002) and gastrointestinal cancer (OR = 2.189, 95% CI = 1.029–4.657, p = 0.042) were the independent risk factors for candidemia, Table 4
Summary
This study was aimed to identify and evaluate the risk factors of candidemia in cancer patients, which will prompt the improvement on current therapeutic strategies and prognosis. Candidemia is one of the most important nosocomial infections and associated with extremely high morbidity and mortality [1, 2]. It was cited as the fourth most prevalent nosocomial bloodstream infection in the United States and seventh to tenth in population-based studies, and the mortality is around 40% [1, 3,4,5]. All risk factors mentioned above dramatically varied on population, living region, underlying diseases, and even the study period and methods applied [17,18,19,20]
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