title: Factors associated with the development of candidemia and candidemia-related death among liver transplant recipients.
abstract: OBJECTIVE
  The authors' objective was to identify factors associated with candidemia and candidemia-related death among adult liver transplant recipients.
  
  
  BACKGROUND
  Invasive candidiasis is the most common severe fungal infection occurring after liver transplantation and is associated with high morbidity and mortality rates. Although candidemia is not always found during invasive candidiasis, it has been considered as an indicator of invasive candidiasis in immunocompromised patients.
  
  
  METHODS
  A time-matched case-control study of 26 patients with candidemia, which was defined as the isolation of Candida from at least one blood culture, and 52 control patients without candidemia was reported. Two control patients were matched with each case patient regarding time of transplantation and duration of follow-up.
  
  
  RESULTS
  Between December 1985 and December 1992, candidemia developed in 1.4% of adult liver transplant recipients a median of 25 days after transplantation (range, 2-1690 days). The overall mortality rate among patients with candidemia was 81%, and 71% of these deaths were related to candidemia. Conditional logistic regression analysis was used to identify factors associated with candidemia, which were 1) hyperglycemia treated with insulin up to 2 weeks before candidemia (odds ratio [OR], 16.15; p = 0.002), and 2) exposure to more than three different intravenous antibiotics before development of candidemia (OR, 11.15; p = 0.005). The variables predictive of death related to candidemia were abdominal surgery performed up to 1 week before candidemia (relative risk [RR], 7.25; p = 0.02), high white blood cell count (RR, 1.10; p = 0.01), lower platelet count (RR, 0.99; p = 0.02), and elevated AST with candidemia (RR, 1.001; p = 0.01).
  
  
  CONCLUSIONS
  Hyperglycemia that requires insulin and exposure to more than three antibiotics are the factors associated with the development of candidemia in liver transplant recipients. When candidemia develops shortly after abdominal surgery and in patients with elevated AST, high white blood cell count, or low platelet count, it is associated with a high mortality rate.
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh Transplantation Institute, Pennsylvania, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Nieto-Rodriguez
authors.forename: S
authors.initials: S
authors.lastname: Kusne
authors.forename: R
authors.initials: R
authors.lastname: Mañez
authors.forename: W
authors.initials: W
authors.lastname: Irish
authors.forename: P
authors.initials: P
authors.lastname: Linden
authors.forename: M
authors.initials: M
authors.lastname: Magnone
authors.forename: E J
authors.initials: EJ
authors.lastname: Wing
authors.forename: J J
authors.initials: JJ
authors.lastname: Fung
authors.forename: T E
authors.initials: TE
authors.lastname: Starzl
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D002177:Candidiasis / Q000209:etiology / Q000401:mortality*; D016022:Case-Control Studies; D016469:Fungemia / Q000209:etiology / Q000401:mortality*; D006801:Humans; D006943:Hyperglycemia / Q000503:physiopathology; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D016015:Logistic Models; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents