title: Candidemia in patients with diabetes mellitus: epidemiology and predictors of mortality.
abstract: Candidemia is the fourth most frequent nosocomial bloodstream infection in the US. The clinical characteristics and outcome of candidemia in adult patients with diabetes mellitus (DM) have not been reported in the literature. The objective of the study was to determine the epidemiology and determinants of mortality in diabetic patients with candidemia. A retrospective cohort study among diabetic patients with candidemia was carried out at 2 medical centers. The primary outcome was death from any cause after the onset of candidemia until discharge from the hospital. A stepwise logistic regression analysis was performed to determine the predictors of mortality. From June 1995 to June 2003, 87 patients with both DM and candidemia were studied. Candida albicans was the most common (48/87, 55%) and Candida glabrata the second most common isolate of candidemia (18/87, 21%). Overall hospital mortality was 39% (34/87). Logistic regression analysis identified 3 independent determinants of death; Apache II score > or =23 (OR 8.3, 95% CI{2.7, 25.4}, p =0.0002), nosocomial candidemia (OR 10.2, 95% CI{1.1, 97.9}, p = 0.04), and mechanical ventilation (OR 3.6, 95% CI{1.1, 11.2}, p = 0.03). The study demonstrates the emergence of non-albicans species of Candida as major causes of candidemia among diabetic patients. The severity of illness reflected by Apache II was the most significant predictor of mortality among diabetic patients with candidemia.
authors.affiliation: Division of Infectious Diseases, Department of Preventive Medicine, University of Kansas Medical Center, Kansas City, MO, USA. msbader1@hotmail.com
authors.forename: Mazen S
authors.initials: MS
authors.lastname: Bader
authors.forename: Sue Min
authors.initials: SM
authors.lastname: Lai
authors.forename: Vinutha
authors.initials: V
authors.lastname: Kumar
authors.forename: Daniel
authors.initials: D
authors.lastname: Hinthorn
mesh_terms: D018806:APACHE; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D048909:Diabetes Complications / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents