Abstract
The aim of the study was to review the epidemiology and prognosis of candidemia in a secondary hospital, and to examine the intra-hospital distribution of candidemia patients. Study design is a retrospective cohort study. Trough 2002–2012, 110 cases of candidemia were diagnosed, giving an incidence of 2, 6/100000 citizens/year. Overall prognosis of candidemia was dismal, with a 30 days case fatality rate of 49% and one year case fatality rate of 64%. Candidemia was a terminal event in 55% of 30 days non-survivors, defined as Candida blood cultures reported positive on the day of death or thereafter (39%), or treatment refrained due to hopeless short-term prognosis (16%). In terminal event candidemias, advanced or incurable cancer was present in 29%. Non-survivors at 30 days were 9 years (median) older than survivors. In 30 days survivors, candidemia was not recognised before discharge in 13% of cases. No treatment were given and no deaths or complications were observed in this group. Candidemia patients were grouped into 8 patient categories: Abdominal surgery (35%), urology (13%), other surgery (11%), pneumonia (13%), haematological malignancy (7%), intravenous drug abuse (4%), other medical (15%), and new-borns (3%). Candidemia was diagnosed while admitted in the ICU in 46% of patients. Urology related cases were all diagnosed in the general ward. Multiple surgical procedures were done in 60% of abdominal surgery patients. Antibiotics were administered prior to candidemia in 87% of patients, with median duration 17 (1–108) days. Neutropenia was less common than expected in patients with candidemia (8/105) and closely associated to haematological malignancy (6/8). Compared with previous national figures the epidemiology of invasive candidiasis seems not to have changed over the last decade.
Highlights
The epidemiology of invasive candidasis varies between regions and countries, with higher rates in north-America than in Europe, and an increasing north-south gradient observed in both [1]
110 individual patients with candidemia were identified over the 11 years period, several with multiple positive cultures, giving an incidence of 2, 6/100000 citizens/year of unique episodes
Candida albicans was by far most prevalent, species distribution and susceptibility patterns are shown in table 1
Summary
The epidemiology of invasive candidasis varies between regions and countries, with higher rates in north-America than in Europe, and an increasing north-south gradient observed in both [1]. Unbiased attributable candidemia mortality is difficult to establish, and the effect of treatment in reducing overall mortality, especially in low prevalence settings remains unclear Risk factors such as central line catheters, parenteral nutrition, steroids, antibiotic usage, renal replacement therapy and diabetes are well recognised but present too often to discriminate patients at risk, and proposed prediction rules are of limited value in low-incidence settings [9,10,11,12]. The aims of study were threefold 1) To investigate the epidemiology of candidemia from 2002–2012 compared with Norwegian national figures for the previous 13 year period [14] 2) To investigate overall outcome and elucidate attributable mortality looking into differences between 30 days survivors and non-survivors, as well as quantifying the risk factors antibiotic usage and surgeries prior to candidemia and 3) To investigate differences in the in-hospital epidemiology of candidemia across wards and specialities, hypothesising candidemia patients would be found predominantly in a limited number of clinical recognisable groups. The study was performed in a large secondary referral hospital with a catchment area covering 7–10% of the Norwegian population, encompassing a broad range of medical and surgical specialities
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
