A prospective observational study of candidemia: epidemiology, therapy, and influences on mortality in hospitalized adult and pediatric patients.
We conducted a prospective, multicenter observational study of adults (n=1447) and children (n=144) with candidemia at tertiary care centers in the United States in parallel with a candidemia treatment trial that included nonneutropenic adults. Candida albicans was the most common bloodstream isolate recovered from adults and children (45% vs. 49%) and was associated with high mortality (47% among adults vs. 29% among children). Three-month survival was better among children than among adults (76% vs. 54%; P<.001). Most children received amphotericin B as initial therapy, whereas most adults received fluconazole. In adults, Candida parapsilosis fungemia was associated with lower mortality than was non-parapsilosis candidemia (24% vs. 46%; P<.001). Mortality was similar among subjects with Candida glabrata or non-glabrata candidemia; mortality was also similar among subjects with C. glabrata candidemia who received fluconazole rather than other antifungal therapy. Subjects in the observational cohort had higher Acute Physiology and Chronic Health Evaluation II scores than did participants in the clinical trial (18.6 vs. 16.1), which suggests that the former subjects are more often excluded from therapeutic trials.
Pappas
Peter G
PG
University of Alabama at Birmingham, 35294-0006, USA. pappas@uab.edu
Rex
John H
JH
Lee
Jeannette
J
Hamill
Richard J
RJ
Larsen
Robert A
RA
Powderly
William
W
Kauffman
Carol A
CA
Hyslop
Newton
N
Mangino
Julie E
JE
Chapman
Stanley
S
Horowitz
Harold W
HW
Edwards
John E
JE
Dismukes
William E
WE
D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D016469:Fungemia / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole