Abstract
Several studies have demonstrated that malnutrition is a negative prognostic factor for clinical outcomes. However, there is limited evidence for the effect of malnutrition on clinical outcomes in patients with candidemia. We investigated the relationship between malnutrition and all-cause 28-day mortality among patients with non-albicans candidemia. Between July 2011 and June 2014, all adult patients with non-albicans candidemia, including C. tropicalis, C. glabrata, C. parapsilosis and so on, were enrolled. The Malnutrition Universal Screening Tool (MUST) scores were used to determine the patients’ nutritional status before the onset of candidemia. A total of 378 patients were enrolled; 43.4% developed septic shock and 57.1% had a high risk of malnutrition (MUST ≥ 2). The all-cause 28-day mortality rate was 40.7%. The Cox proportional hazards model revealed that C. tropicalis (HR, 2.01; 95% CI, 1.24–3.26; p = 0.005), Charlson comorbidity index (HR, 1.10; 95% CI, 1.03–1.18; p = 0.007), Foley catheter use (HR, 1.68; 95% CI, 1.21–1.35; p = 0.002), concomitant bacterial infections (HR, 1.55; 95% CI, 1.11–2.17; p = 0.010), low platelet count (HR, 3.81; 95% CI, 2.45–5.91; p < 0.001), not receiving antifungals initially (HR, 4.73; 95% CI, 3.07–7.29; p < 0.001), and MUST ≥ 2 (HR, 1.54; 95% CI, 1.09–2.17; p = 0.014) were independently associated with all-cause 28-day mortality. A simple screening tool for nutritional assessment should be used for patients with non-albicans candidemia to detect early clinical deterioration, and a tailored nutritional care plan should be established for malnourished individuals, to improve their clinical outcomes.
Highlights
Candida, one of the most frequently encountered invasive fungal infections in humans, causes a wide spectrum of clinical manifestations, including candidemia, intra-abdominal infections, and osteomyelitis [1]
Different fatality rates have been observed based on different Candida species, and it seems that patients with non-albicans candidemia have a worse prognosis [13]
This study aimed to compare the clinical characteristics of non-albicans candidemic patients with a high risk of malnutrition to those of patients without a high risk and antifungal susceptibility, and to identify the predictors of all-cause 28-day mortality among patients with non-albicans candidemia
Summary
One of the most frequently encountered invasive fungal infections in humans, causes a wide spectrum of clinical manifestations, including candidemia, intra-abdominal infections, and osteomyelitis [1]. MUST, the foundation for the NRS-2002, was established to recognize individuals with malnourishment in all healthcare settings. It had three components: calculation of the body mass index (BMI) as well as recording of the percentage of unintentional weight loss in the past months and the presence of acute sickness with a reduction in nutritional intake for days [22]. Limited research has been done on the influence of malnourishment on the clinical outcomes of patients with non-albicans candidemia. This study aimed to compare the clinical characteristics of non-albicans candidemic patients with a high risk of malnutrition to those of patients without a high risk and antifungal susceptibility, and to identify the predictors of all-cause 28-day mortality among patients with non-albicans candidemia
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