Abstract
Background: Candidemias are becoming a growing problem for reasons such as the increasing need for both broad spectrum antibiotic use and total parenteral nutrition and the prolongation of life spans of patients with malignancies. The fact that, despite all the technological advances that have been made, Candida spp. are seen in 50% of blood cultures shows that the problem is more serious than previously thought. The purpose of our study was to evaluate patients with candidemia and determine the importance of scoring systems. Methods: Patients with Candida spp. growth in blood cultures between 2009-2014 were investigated retrospectively. Patients’ demographic and clinical characteristics, laboratory results, time to start of appropriate treatment, Charlson comorbidity index (CCI), SOFA and Pitt scores and prognoses were recorded from medical files and infection control committee records. Results: One hundred fifteen patients were enrolled. Agents identified were Candida albicans in 41.7% of cases and Candida non-albicans in 58.3%. The crude mortality rate in the patients enrolled in the study was 65.2%. CCI, SOFA and Pitt scores were significantly high in the non-surviving patients. Multivariate analysis of the risk factors affecting mortality showed that a 1-unit increase in a patient’s CCI, SOFA and Pitt scores increased mortality 1.6, 1.3 and 2.0 fold, respectively, and that failure to start appropriate antifungal therapy in the first 3 days increased mortality 4.6-fold. Conclusion: The use of CCI, SOFA and Pitt scoring systems during evaluation in patients with risk factors and prompt initiation of antifungal therapy in patients with scores above cut-off values can be life-saving.
Highlights
Candidemias are becoming a growing problem for reasons such as the increasing need for both broad spectrum antibiotic use and total parenteral nutrition and the prolongation of life spans of patients with malignancies [1]
The purpose of our study was to determine the place of the Pitt score, SOFA, and Charlson comorbidity index (CCI) in identifying patients with Candidemia and to establish whether the use of these systems alone or in combination might contribute to the initiation of effective treatment through diagnosis in the early period
Agents identified were Candida albicans in 41.7%, Candida guillermondi in 20%, Candida parapsilosis in 17.4%, Candida tropicalis in 7%, and other non-albicans Candida species in 13.9%
Summary
Candidemias are becoming a growing problem for reasons such as the increasing need for both broad spectrum antibiotic use and total parenteral nutrition and the prolongation of life spans of patients with malignancies [1]. Studies have shown that these techniques have low positive predictive values (PPV) but high negative predictive values (NPV) Another significant disadvantage of these scoring systems is that they require the collection of consecutive multiple cultures from the same patient. The lack of a method with high sensitivity in diagnosing Candidemia, in at-risk patient groups, results in diagnostic difficulties and delays in the commencement of effective treatment, and to marked increases in mortality and patient costs. For all these reasons, rather than patients’ symptoms, findings and laboratory results being evaluated individually, scoring systems are required that are capable of assessing all these together. Conclusion: The use of CCI, SOFA and Pitt scoring systems during evaluation in patients with risk factors and prompt initiation of antifungal therapy in patients with scores above cut-off values can be life-saving
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