title: Epidemiology and predictors of mortality in cases of Candida bloodstream infection: results from population-based surveillance, barcelona, Spain, from 2002 to 2003.
abstract: We conducted population-based surveillance for Candida bloodstream infections in Spain to determine its incidence, the extent of antifungal resistance, and risk factors for mortality. A case was defined as the first positive blood culture for any Candida spp. in a resident of Barcelona, from 1 January 2002 to 31 December 2003. We defined early mortality as occurring between days 3 to 7 after candidemia and late mortality as occurring between days 8 to 30. We detected 345 cases of candidemia, for an average annual incidence of 4.3 cases/100,000 population, 0.53 cases/1,000 hospital discharges, and 0.73 cases/10,000 patient-days. Outpatients comprised 11% of the cases, and 89% had a central venous catheter (CVC) at diagnosis. Overall mortality was 44%. Candida albicans was the most frequent species (51% of cases), followed by Candida parapsilosis (23%), Candida tropicalis (10%), Candida glabrata (8%), Candida krusei (4%), and other species (3%). Twenty-four isolates (7%) had decreased susceptibility to fluconazole (MIC > or = 16 microg/ml). On multivariable analysis, early death was independently associated with hematological malignancy (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.1 to 10.4). Treatment with antifungals (OR, 0.05; 95% CI, 0.01 to 0.2) and removal of CVCs (OR, 0.3; 95% CI, 0.1 to 0.9) were protective factors for early death. Receiving adequate treatment, defined as having CVCs removed and administration of an antifungal medication (OR, 0.2; 95% CI, 0.08 to 0.8), was associated with lower odds of late mortality; intubation (OR, 7.5; 95% CI, 2.6 to 21.1) was associated with higher odds. The incidence of candidemia and prevalence of fluconazole resistance are similar to other European countries, indicating that routine antifungal susceptibility testing is not warranted. Antifungal medication and catheter removal are critical in preventing mortality.
authors.affiliation: Infectious Diseases Division, Hospital Universitari Vall d'Hebron, Avda. Vall d'Hebron, 119-129, 08035 Barcelona, Spain. balmirante@vhebron.net
authors.forename: Benito
authors.initials: B
authors.lastname: Almirante
authors.forename: Dolors
authors.initials: D
authors.lastname: Rodríguez
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Park
authors.forename: Manuel
authors.initials: M
authors.lastname: Cuenca-Estrella
authors.forename: Ana M
authors.initials: AM
authors.lastname: Planes
authors.forename: Manuel
authors.initials: M
authors.lastname: Almela
authors.forename: Jose
authors.initials: J
authors.lastname: Mensa
authors.forename: Ferran
authors.initials: F
authors.lastname: Sanchez
authors.forename: Josefina
authors.initials: J
authors.lastname: Ayats
authors.forename: Montserrat
authors.initials: M
authors.lastname: Gimenez
authors.forename: Pere
authors.initials: P
authors.lastname: Saballs
authors.forename: Scott K
authors.initials: SK
authors.lastname: Fridkin
authors.forename: Juliette
authors.initials: J
authors.lastname: Morgan
authors.forename: Juan L
authors.initials: JL
authors.lastname: Rodriguez-Tudela
authors.forename: David W
authors.initials: DW
authors.lastname: Warnock
authors.forename: Albert
authors.initials: A
authors.lastname: Pahissa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology; D002175:Candida / Q000145:classification* / Q000187:drug effects; D002177:Candidiasis / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D025141:Drug Resistance, Fungal; D005260:Female; D015725:Fluconazole / Q000494:pharmacology; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011159:Population Surveillance; D011237:Predictive Value of Tests; D013030:Spain / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole