Risk factors for fatal candidemia caused by Candida albicans and non-albicans Candida species.
BACKGROUND
Invasive fungal infections, such as candidemia, caused by Candida species have been increasing. Candidemia is not only associated with a high mortality (30% to 40%) but also extends the length of hospital stay and increases the costs of medical care. Sepsis caused by Candida species is clinically indistinguishable from bacterial infections. Although, the clinical presentations of the patients with candidemia caused by Candida albicans and non-albicans Candida species (NAC) are indistinguishable, the susceptibilities to antifungal agents of these species are different. In this study, we attempted to identify the risk factors for candidemia caused by C. albicans and NAC in the hope that this may guide initial empiric therapy.


METHODS
A retrospective chart review was conducted during 1996 to 1999 at the Veterans General Hospital-Taipei.


RESULTS
There were 130 fatal cases of candidemia, including 68 patients with C. albicans and 62 with NAC. Candidemia was the most likely cause of death in 55 of the 130 patients (42.3 %). There was no significant difference in the distribution of Candida species between those died of candidemia and those died of underlying conditions. Patients who had one of the following conditions were more likely to have C. albicans, age > or = 65 years, immunosuppression accounted to prior use of steroids, leukocytosis, in the intensive care unit (ICU), and intravascular and urinary catheters. Patients who had undergone cancer chemotherapy often appeared less critically ill and were more likely to have NAC.


CONCLUSIONS
Clinical and epidemiological differences in the risk factors between candidemia caused by C. albicans and NAC may provide helpful clues to initiate empiric therapy for patients infected with C. albicans versus NAC.
Cheng
Ming-Fang
MF
Department of Pediatrics, Veterans General Hospital-Kaohsiung, Kaohsiung, Taiwan. mfcheng@vghks.gov.tw
Yang
Yun-Liang
YL
Yao
Tzy-Jyun
TJ
Lin
Chin-Yu
CY
Liu
Jih-Shin
JS
Tang
Ran-Bin
RB
Yu
Kwok-Woon
KW
Fan
Yu-Hua
YH
Hsieh
Kai-Sheng
KS
Ho
Monto
M
Lo
Hsiu-Jung
HJ
D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000368:Aged; D000375:Aging; D002175:Candida / Q000145:classification* / Q000472:pathogenicity* / Q000502:physiology; D002177:Candidiasis / Q000209:etiology / Q000382:microbiology* / Q000401:mortality*; D002404:Catheterization / Q000009:adverse effects; D016469:Fungemia / Q000209:etiology / Q000382:microbiology* / Q000401:mortality*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007362:Intensive Care Units; D007964:Leukocytosis / Q000150:complications; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013045:Species Specificity
D000305:Adrenal Cortex Hormones