The predictors of outcome in immunocompetent patients with hematogenous candidiasis.
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.
Safdar
Amar
A
University of South Carolina School of Medicine, Columbia, SC 29203, USA.
Bannister
Thomas W
TW
Safdar
Zeenat
Z
D000293:Adolescent; D000328:Adult; D000368:Aged; D001769:Blood / Q000382:microbiology; D002175:Candida / Q000145:classification / Q000302:isolation & purification*; D002176:Candida albicans / Q000302:isolation & purification; D002177:Candidiasis / Q000382:microbiology / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D003470:Culture Media; D005260:Female; D016469:Fungemia / Q000382:microbiology / Q000401:mortality*; D006801:Humans; D007121:Immunocompetence; D016867:Immunocompromised Host; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications; D011237:Predictive Value of Tests
D003470:Culture Media