Candida glabrata Fungemia. Clinical features of 139 patients.
Candida species are now the fourth leading cause of nosocomial bloodstream infection in hospitalized patients, and non-Candida albicans species now surpass Candida albicans. The clinical features of the most common non-Candida albicans species, Candida (Torulopsis) glabrata, have not been well studied. We retrospectively reviewed the clinical features of 139 patients with C. glabrata blood-stream infection over a period of 7 years. The mean age of patients was 62 years, and the most common admitting diagnoses were malignancy (28%) and coronary artery disease (18%). The most common identified portals of entry were abdominal (22%) and intravascular catheters (16%). At the time of fungemia, 63% of patients had fever, 45% had change in mental status, and 30% were in septic shock. Three of 50 patients examined by an ophthalmologist had chorioretinitis. The overall hospital mortality was 49%. Factors associated with increased mortality in a regression model were prior abdominal surgery (odds ratio [OR] = 2.8; 95% confidence interval [CI] = 1.2-6.3, p = 0.01), and an elevated creatinine (OR = 2.2; 95% CI = 1.0-4.7, p = 0.05). When early deaths (< or = 72 hours) were censored, amphotericin B treatment and total dose were associated with reduced mortality (OR = 0.2; 95% CI = 0.1-0.4, p < 0.001). Nosocomial C. glabrata fungemia is not just a disease of debilitated and neutropenic patients, but affects a wide variety of patients and is associated with a high mortality.
Gumbo
T
T
Department of Infectious Disease, Cleveland Clinic Foundation, Ohio 44195, USA.
Isada
C M
CM
Hall
G
G
Karafa
M T
MT
Gordon
S M
SM
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002177:Candidiasis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D016469:Fungemia / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009820:Ohio / Q000453:epidemiology; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome