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.
