Background
Patients and methods
Subjects and data collection
Microbiological analysis
Statistical analysis
Results
Candida species distribution
Characteristics | Surgical patients (n = 172) | Non-surgical patients (n = 64) | P value |
---|---|---|---|
Age | 62.5 ± 14.2 | 55.0 ± 21.9 | 0.002 |
Age ≥ 65 years | 75 (43.6%) | 22 (34.4%) | 0.2 |
Male sex | 119 (69.2%) | 41 (64.1%) | 0.45 |
Underlying diseases | |||
Hematological malignancy | 1 (0.6%) | 15 (23.4%) | < 0.001 |
Solid tumors | 90 (52.3%) | 8 (12.5%) | < 0.001 |
Diabetes mellitus | 32 (18.6%) | 24 (37.5%) | 0.002 |
Predisposing factors | |||
Renal replacement therapy | 7 (4.1%) | 15 (23.4%) | < 0.001 |
Current and former smokers | 52 (30.2%) | 18 (28.1%) | 0.75 |
ICU stay | 63 (36.6%) | 20 (31.3%) | 0.44 |
Prior antibiotics exposure | 166 (96.5%) | 52 (81.3%) | < 0.001 |
Prior antifungal exposure | 25 (14.5%) | 12 (18.8%) | 0.43 |
TPN | 162 (94.2%) | 26 (40.6%) | < 0.001 |
Presence of CVC | 67 (39.0%) | 26 (40.6%) | 0.82 |
Mechanical ventilation | 20 (11.6%) | 8 (12.5%) | 0.85 |
Presence of urinary catheter | 127 (73.8%) | 21 (32.8%) | < 0.001 |
Presence of gastric tube | 132 (76.7%) | 23 (35.9%) | < 0.001 |
Laboratory findings | |||
Renal failure | 31 (18%) | 26 (40.6%) | < 0.001 |
Anemia | 144 (83.7%) | 55 (85.9%) | 0.68 |
Hypoalbuminemia | 71 (41.3%) | 31 (48.4%) | 0.32 |
Hyponatremia | 73 (42.4%) | 18 (28.1%) | 0.045 |
Leukopenia | 19 (11%) | 19 (29.7%) | 0.001 |
Thrombocytopenia | 24 (14.0%) | 24 (37.5%) | < 0.001 |
C. albicans infection | 58 (33.7%) | 25 (39.1%) | 0.45 |
C. parapsilosis infection | 74 (43.0%) | 15 (23.4%) | 0.006 |
C. glabrata infection | 19 (11%) | 10 (15.6%) | 0.34 |
C. tropicalis infection | 14 (8.1%) | 13 (20.3%) | 0.009 |
Fluconazole susceptibility | 126 (73.3%) | 44 (68.8%) | 0.50 |
Empirical antifungal therapy | 115 (66.9%) | 40 (62.5%) | 0.53 |
No antifungal therapy | 27 (15.7%) | 9 (14.1%) | 0.76 |
Outcome | |||
30-day mortality | 33 (19.2%) | 18 (28.1%) | 0.14 |
LOS (days) | 32 (22.3–47.8) | 26 (15–47) | 0.02 |
Patient characteristics
Antifungal susceptibility testing
Species | Antifungal agent | MIC (μg/ml) | No. (%) of isolates by new CBPsa | ||||
---|---|---|---|---|---|---|---|
(n = 172) | Ranges | MIC50 | MIC90 | S | SDD / I | R | |
C. albicans (n = 58) | Fluconazole | ≤0.5–16 | ≤1 | 4 | 50 (86.2%) | 6 (10.3%) | 2 (3.4%) |
Voriconazole | ≤0.03- ≤ 4 | 0.06 | ≤1 | 49 (84.5%) | 3 (5.2%) | 6 (10.3%) | |
Itraconazole | 0.062–1 | ≤0.125 | 0.25 | NA | NA | NA | |
Amphotericin B | ≤0.25–1 | ≤0.5 | 0.5 | 58 (100%) | 0 | 0 | |
C. parapsilosis (n = 74) | Fluconazole | ≤0.5–8 | ≤1 | ≤4 | 65 (87.8%) | 8 (10.8%) | 1 (1.4%) |
Voriconazole | ≤0.03–0.25 | ≤0.06 | 0.125 | 72 (97.3%) | 2 (2.7%) | 0 | |
Itraconazole | ≤0.062–0.25 | ≤0.125 | 0.125 | 72 (97.3%) | 0 | 2 (2.7%) | |
Amphotericin B | ≤0.25–1 | ≤0.5 | 0.5 | 74 (100%) | 0 | 0 | |
C. glabrata (n = 19) | Fluconazole | ≤1–16 | 4 | 16 | 0 | 19 (100%) | 0 |
Voriconazole | ≤0.06–0.5 | 0.125 | 0.25 | NA | NA | NA | |
Itraconazole | ≤0.125–1 | 0.25 | 1 | NA | NA | NA | |
Amphotericin B | ≤0.25–1 | ≤0.5 | 0.5 | 19 (100%) | 0 | 0 | |
C. tropicalis (n = 14) | Fluconazole | ≤1–32 | 1 | 16 | 11 (78.6%) | 1 (7.1%) | 2 (14.3%) |
Voriconazole | ≤0.06–4 | 0.06 | 0.5 | 12 (85.7%) | 1 (7.1%) | 1 (7.1%) | |
Itraconazole | ≤0.125–8 | 0.125 | 1 | 10 (71.4%) | 0 | 4 (28.6%) | |
Amphotericin B | ≤0.25–0.5 | ≤0.5 | 0.5 | 14 (100%) | 0 | 0 | |
C. kruseib (n = 1) | Fluconazole | 64 | 0 | 0 | 1 (100%) | ||
Voriconazole | 0.5 | 1 (100%) | 0 | 0 | |||
Itraconazole | 1 | NA | NA | NA | |||
Amphotericin B | 1 | 1 (100%) | 0 | 0 | |||
Others (n = 6) | Fluconazole | ≤1–16 | ≤2 | 16 | NA | NA | NA |
Voriconazole | ≤0.06–2 | ≤0.06 | 2 | NA | NA | NA | |
Itraconazole | ≤0.125–1 | 0.125 | 1 | NA | NA | NA | |
Amphotericin B | ≤0.5–0.5 | ≤0.5 | 0.5 | NA | NA | NA |
Antifungal therapy, outcomes and prognostic factors of candidemia in surgical patients
Variable | Survivors n = 139 (80.8%) | Deaths n = 33 (19.2%) | Odds ratio | 95% Confidence interval | P value |
---|---|---|---|---|---|
Age | 61.6 ± 14.4 | 66.5 ± 12.6 | 1.03 | 1–1.06 | 0.07 |
Age ≥ 65 years | 57 (41.0%) | 18 (54.5%) | 1.73 | 0.8–3.71 | 0.16 |
Male sex | 97 (69.8%) | 22 (66.7%) | 0.87 | 0.39–1.95 | 0.73 |
Underlying diseases | |||||
Solid tumors | 77 (55.4%) | 13 (39.4%) | 0.52 | 0.24–1.14 | 0.10 |
Diabetes mellitus | 24 (17.3%) | 8 (24.2%) | 1.53 | 0.62–3.81 | 0.36 |
Predisposing factors | |||||
Current and former smokers | 42 (30.2%) | 10 (30.3%) | 1 | 0.44–2.29 | 0.99 |
ICU stay | 38 (27.3%) | 25 (75.8%) | 8.31 | 3.45–20.01 | < 0.001 |
Recent abdominal surgery | 118 (84.9%) | 23 (69.7%) | 0.41 | 0.17–0.98 | 0.046 |
Recent cancer surgery | 74 (53.2%) | 11 (33.3%) | 0.44 | 0.2–0.97 | 0.04 |
Prior antibiotics exposure | 134 (96.4%) | 32 (97.0%) | 1.19 | 0.13–10.58 | 0.87 |
Prior antifungal exposure | 20 (14.4%) | 5 (15.2%) | 1.06 | 0.37–3.08 | 0.91 |
TPN | 130 (93.5%) | 32 (97.0%) | 2.22 | 0.27–18.13 | 0.46 |
Presence of CVC | 49 (35.3%) | 18 (54.5%) | 2.2 | 1.02–4.75 | 0.04 |
Mechanical ventilation | 15 (10.8%) | 5 (15.2%) | 1.48 | 0.5–4.4 | 0.48 |
Presence of urinary catheter | 106 (76.3%) | 21 (63.6%) | 0.54 | 0.24–1.22 | 0.14 |
Presence of gastric tube | 109 (78.4%) | 23 (69.7%) | 0.63 | 0.27–1.47 | 0.29 |
Laboratory findings | |||||
Renal failure | 17 (12.2%) | 14 (42.4%) | 5.29 | 2.24–12.46 | < 0.001 |
Anemia | 116 (83.5%) | 28 (84.8%) | 1.11 | 0.39–3.18 | 0.85 |
Hypoalbuminemia | 47 (33.8%) | 24 (72.7%) | 5.22 | 2.25–12.13 | < 0.001 |
Hyponatremia | 67 (48.2%) | 6 (18.2%) | 0.24 | 0.09–0.61 | 0.003 |
Leukopenia | 14 (10.1%) | 5 (15.2%) | 1.59 | 0.53–4.79 | 0.41 |
Thrombocytopenia | 10 (7.2%) | 14 (42.4%) | 9.51 | 3.7–24.42 | < 0.001 |
C. albicans infection | 39 (28.1%) | 19 (57.6%) | 3.48 | 1.59–7.62 | 0.002 |
C. parapsilosis infection | 67 (48.2%) | 7 (21.2%) | 0.29 | 0.12–0.71 | 0.007 |
C. glabrata infection | 15 (10.8%) | 4 (12.1%) | 1.14 | 0.35–3.69 | 0.83 |
C. tropicalis infection | 11 (7.9%) | 3 (9.1%) | 1.16 | 0.31–4.43 | 0.82 |
Fluconazole susceptibility | 103 (74.1%) | 23 (69.7%) | 0.8 | 0.35–1.85 | 0.61 |
Empirical antifungal therapy | 94 (67.6%) | 21 (63.6%) | 0.84 | 0.38–1.85 | 0.66 |
No antifungal therapy | 22 (15.8%) | 5 (15.2%) | 0.95 | 0.33–2.73 | 0.92 |
Outcome | |||||
LOS (days) | 33 (22–48) | 31 (23–41.5) | 1 | 0.98–1.01 | 0.52 |
Variable | Adjusted odds ratio | 95% Confidence interval | P Value |
---|---|---|---|
Age | 1.04 | 1.0–1.08 | 0.06 |
Solid tumors | 0.89 | 0.07–10.71 | 0.93 |
ICU stay | 6.55 | 1.85–23.22 | 0.004 |
Recent abdominal surgery | 0.33 | 0.09–1.24 | 0.1 |
Recent cancer surgery | 0.67 | 0.05–8.88 | 0.76 |
Presence of CVC | 0.98 | 0.28–3.38 | 0.97 |
Renal failure | 1.78 | 0.54–5.95 | 0.35 |
Hypoalbuminemia | 2.78 | 0.94–8.2 | 0.06 |
Hyponatremia | 0.35 | 0.1–1.24 | 0.10 |
Thrombocytopenia | 5.72 | 1.54–21.20 | 0.009 |
C.albicans infection | 6.08 | 1.53–24.19 | 0.01 |
C. parapsilosis infection | 1.07 | 0.24–4.7 | 0.93 |