Mortality-associated factors of candidemia: a multi-center prospective cohort in Turkey


KUTLU M., SAYIN KUTLU S., ALP ÇAVUŞ S., ÖZTÜRK Ş. B. , TAŞBAKAN M., ÖZHAK B., ...More

EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES, vol.41, no.4, pp.597-607, 2022 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 41 Issue: 4
  • Publication Date: 2022
  • Doi Number: 10.1007/s10096-021-04394-0
  • Journal Name: EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, PASCAL, Agricultural & Environmental Science Database, CAB Abstracts, EMBASE, Environment Index, MEDLINE, Public Affairs Index, Veterinary Science Database
  • Page Numbers: pp.597-607
  • Keywords: Candida, Candida parapsilosis, Catheter removal, Mortality, Risk factors, CRITICALLY-ILL PATIENTS, BLOOD-STREAM INFECTION, INTENSIVE-CARE-UNIT, RISK-FACTORS, SPECIES DISTRIBUTION, ANTIFUNGAL THERAPY, INVASIVE CANDIDIASIS, FLUCONAZOLE THERAPY, SEPTIC SHOCK, EPIDEMIOLOGY
  • Süleyman Demirel University Affiliated: Yes

Abstract

Candidemia may present as severe and life-threatening infections and is associated with a high mortality rate. This study aimed to evaluate the risk factors associated with 30-day mortality in patients with candidemia. A multi-center prospective observational study was conducted in seven university hospitals in six provinces in the western part of Turkey. Patient data were collected with a structured form between January 2018 and April 2019. In total, 425 episodes of candidemia were observed during the study period. Two hundred forty-one patients died within 30 days, and the 30-day crude mortality rate was 56.7%. Multivariable analysis found that SOFA score (OR: 1.28, CI: 1.154-1.420, p < 0.001), parenteral nutrition (OR: 3.9, CI: 1.752-8.810, p = 0.001), previous antibacterial treatment (OR: 9.32, CI: 1.634-53.744,p = 0.012), newly developed renal failure after candidemia (OR: 2.7, CI: 1.079-6.761, p=0.034), and newly developed thrombocytopenia after candidemia (OR: 2.6, CI: 1. 057-6.439, p =0.038) were significantly associated with 30-day mortality. Central venous catheter removal was the only factor protective against mortality (OR: 0.34, CI:0.147-0.768, p = 0.010) in multivariable analysis. Candidemia mortality is high in patients with high SOFA scores, those receiving TPN therapy, and those who previously received antibacterial therapy. Renal failure and thrombocytopenia developing after candidemia should be followed carefully in patients. Antifungal therapy and removing the central venous catheter are essential in the management of candidemia.