The predictors of outcome in immunocompetent patients with hematogenous candidasis

Abstract

Objective: Clinical parameters that predict outcome in non-immunosuppressed candidemic patients are not fully understood. Methods: Eighty-one consecutive episodes of candidemia were retrospectively evaluated in 75 patients during 1998–2000. Results: Infection due to Candida albicans was common ( n=30; 37%) followed by Candida glabrata ( n=25; 31%), Candida parapsilosis ( n=14; 17%), Candida tropicalis ( n=6; 7%), Candida krusei ( n=5; 6%), and Candida lusitaniae ( n=1; 1%). Among 70 evaluable patients, 31 (44%) had fungemia-associated mortality; advanced age ( P<0.004), underlying malignancy ( P<0.025), coronary artery disease ( P<0.01), and concurrent non- Candida species fungal infection ( P<0.047) were significant prognosticators of compromised short-term survival by multivariate analysis. Mortality was higher in patients with Candida glabrata (60%) and C. tropicalis (75%) infection compared to 44% deaths in individuals with C. albicans infection ( P>0.1). 11/25 (44%) of non-immunocompromised individuals died and 20/45 (44%) immunosuppressed patients succumbed to fungemia: persistent vs. non-persistent (<3 days) Candida bloodstream invasion, neutropenia, diabetes mellitus, renal insufficiency, prior antimicrobial therapy, cirrhosis of liver, abdomino-pelvis surgery, and critical-care-unit vs. non critical-care-unit admission did not significantly impact outcome in either group. All 11 infants, including nine with prematurity survived Candida species bloodstream infection ( P<0.025). Conclusions: Short-term mortality in candidemic non-immunocompromised patients was comparable to fungemia-associated deaths in immunosuppressed patients. Ischemic heart disease has appeared as a new predictor of unfavorable outcome in patients with hematogenous candidiasis.