Risk factors for fatal candidemia caused by Candida albicans and non-albicans Candida species

Ming-Fang Cheng,Kai-Sheng Hsieh,Yun-Liang Yang,Jih-Shin Liu,Kwok-Woon Yu,Monto Ho,Yu-Hua Fan,Ran-Bin Tang,Hsiu-Jung Lo,Chin-Yu Lin,Tzy-Jyun Yao

doi:10.1186/1471-2334-5-22

Abstract

BackgroundInvasive fungal infections, such as candidemia, caused by Candida species have been increasing. Candidemia is not only associated with a high mortality (30% to 40%) but also extends the length of hospital stay and increases the costs of medical care. Sepsis caused by Candida species is clinically indistinguishable from bacterial infections. Although, the clinical presentations of the patients with candidemia caused by Candida albicans and non-albicans Candida species (NAC) are indistinguishable, the susceptibilities to antifungal agents of these species are different. In this study, we attempted to identify the risk factors for candidemia caused by C. albicans and NAC in the hope that this may guide initial empiric therapy.MethodsA retrospective chart review was conducted during 1996 to 1999 at the Veterans General Hospital-Taipei.ResultsThere were 130 fatal cases of candidemia, including 68 patients with C. albicans and 62 with NAC. Candidemia was the most likely cause of death in 55 of the 130 patients (42.3 %). There was no significant difference in the distribution of Candida species between those died of candidemia and those died of underlying conditions. Patients who had one of the following conditions were more likely to have C. albicans, age ≧ 65 years, immunosuppression accounted to prior use of steroids, leukocytosis, in the intensive care unit (ICU), and intravascular and urinary catheters. Patients who had undergone cancer chemotherapy often appeared less critically ill and were more likely to have NAC.ConclusionClinical and epidemiological differences in the risk factors between candidemia caused by C. albicans and NAC may provide helpful clues to initiate empiric therapy for patients infected with C. albicans versus NAC.

Highlights

Invasive fungal infections, such as candidemia, caused by Candida species have been increasing
Clinical data Clinical data of 130 patients were recorded on standardized forms and analyzed according to age at the time of diagnosis, gender and underlying illnesses. These included cancer, diabetes, immunosuppression accounted to prior use of steroids, systemic antifungal agents, cancer chemotherapy, parenteral nutrition, the presence of central or arterial line, endotracheal tube, and urinary catheter, admission to an intensive care unit (ICU), history of infection or gastrointestinal surgery, hemogram, antifungal management, and cause of death
Of the four major species related to candidemia, 61.5% of the isolated Candida glabrata contributed to mortality, followed by 50% of Candida parapsilosis, 41.2% of C. albicans, and 31.3% of Candida tropicalis

Summary

Introduction

Invasive fungal infections, such as candidemia, caused by Candida species have been increasing. Candidemia is associated with a high mortality (30% to 40%) and extends the length of hospital stay and increases the costs of medical care. The clinical presentations of the patients with candidemia caused by Candida albicans and non-albicans Candida species (NAC) are indistinguishable, the susceptibilities to antifungal agents of these species are different. Candidemia is associated with a mortality of about 30% to 40% and extends the duration of hospital stay [3,4] and increases the cost for medical care [5]. Empirical antifungal agents may be administrated to patients manifested with fever of unknown origin and have above mentioned risk factors, those who have been treated with broad-spectrum antibiotics. NAC are often less susceptible to fluconazole than C. albicans is [7,11,12] and may require greater dosage to cure clinically [13,14]

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Results

Discussion

Conclusion