Risk Factors for Mortality in Colombian Patients with Candidemia.

Jorge Alberto Cortés,Carlos Hernando Gómez,Angela Pescador,Patricia Reyes,Ana María Carreño-Gutiérrez,Fernando Rosso,Beatriz Ariza,Anita María Montañez

doi:10.3390/jof7060442

Abstract

The aim of the study was to describe the microbiology and susceptibility profile of candidemia and to identify the risk factors associated with mortality in Colombia. A cohort of patients was followed for 30 days during 2008 to 2010. Microbiological identification and susceptibility assessments were performed in a reference centre. Demographic, clinical and treatment variables were evaluated for their associations with mortality. A parametric survival regression analysis was used to identify the risk factors associated with mortality. A total of 109 patients with candidemia in four hospitals in Colombia were identified, with a median age of 30 years old. C. parapsilosis was the most frequently identified microorganism (38.5%); the susceptibility of all isolates was high to fluconazole and anidulafungin, except for C. glabrata isolates. The overall mortality was 35.7%, and the risk factors associated with mortality included lack of antifungal treatment (HR 5.5, 95% CI 3.6–11.4), cancer (HR 3.9, 95% CI 2.3–8.0), diabetes (HR 2.5, 95% CI 1.03–6.4), and age (HR 1.13 per every 10 years, 95% CI 1.02–1.24). Catheter removal was associated with a low mortality rate (HR 0.06, 95% CI 0.00–0.49). Prompt antifungal treatment, better glycemic control and catheter removal should be prioritized in the management of candidemia.

Highlights

Candidemia is the fourth leading cause of infection in the bloodstream in the UnitedStates and the sixth cause in Latin America [1,2], as well as the most common fungal infection in hospitalized patients, especially in critically ill patients, independent of immunological status
Between 2008 and 2010, a surveillance study of candidemia was performed in seven Latin American countries and showed a high incidence of candidemia and slightly increased numbers in Colombia in comparison to those of the region region (1.96 cases per 1000 admissions vs. 1.18 cases per 1000 admissions) [5,8]
The present study presents the results of a laboratory-based surveillance of candidemia in Colombia as part of the Latin American effort to improve the knowledge of Candida epidemiology in the region

Summary

Introduction

Candidemia is the fourth leading cause of infection in the bloodstream in the UnitedStates and the sixth cause in Latin America [1,2], as well as the most common fungal infection in hospitalized patients, especially in critically ill patients, independent of immunological status. A higher number of nosocomial infections have been described in the region [6], and studies have shown a relatively high incidence of candidemia with a high mortality [7]. Between 2008 and 2010, a surveillance study of candidemia was performed in seven Latin American countries and showed a high incidence of candidemia and slightly increased numbers in Colombia in comparison to those of the region region (1.96 cases per 1000 admissions vs 1.18 cases per 1000 admissions) [5,8]. The present study presents the results of a laboratory-based surveillance of candidemia in Colombia as part of the Latin American effort to improve the knowledge of Candida epidemiology in the region

Objectives

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Results

Conclusion