Hospital-acquired candidemia in HIV-infected patients. Incidence, risk factors and predictors of outcome.
A retrospective case-control study was performed to analyze hospital-acquired candidemia in HIV-positive patients. To understand the impact of Highly Active Antiretroviral Therapy (HAART) on the incidence of nosocomial candidemia, two time periods were compared: A (1992-1996) and B (1997-2001). 32 out of 38 (84%) cases of candidemia were hospital-related. A significant reduction in the incidence of all cases of hospital-acquired candidemia has been observed in the post-HAART in respect to pre-HAART period (0.09 episodes vs. 1.1 per 100/py). Multivariate analysis showed that the presence of central venous catheter was the only variable independently associated with the development of nosocomial candidemia. The overall mortality rate was 59%. Univariate analysis indicated three prognostic indicators: presence of concomitant opportunistic infections, isolation of non-albicans Candida species; neutropenia. Multivariate analysis of prognostic indicators showed that isolation of non-albicans Candida species is the only independent variable. Despite the use of HAART, this disease still represents a severe complication of advanced stage of AIDS.
Bertagnolio
S
S
Department of Infectious Diseases, Catholic University Medical School, Rome, Italy.
de Gaetano Donati
K
K
Tacconelli
E
E
Scoppettuolo
G
G
Posteraro
B
B
Fadda
G
G
Cauda
R
R
Tumbarello
M
M
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D002177:Candidiasis / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D005260:Female; D016469:Fungemia / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors