Incidence, risk factors, and predictors of outcome of candidemia. Survey in 2 Italian university hospitals.
In recent decades, Candida spp. emerged as the fourth most common cause of nosocomial bloodstream infections. The incidence of candidemia was 0.13 per 100 persons. Eighty-three cases (61%) of candidemia were due to Candida albicans and 53 (39%) to nonalbicans Candida spp. Twelve strains of Candida (9%) had shown in vitro resistance to fluconazole, 5 (4%) to itraconazole, 2 (1.5%) to voriconazole, 12 (9%) to 5-flucytosine, and 1 (0.7%) to amphotericin B. Multivariate logistic regression analysis of risk factors showed that length of hospitalization, presence of a central venous catheter, previous episodes of candidemia or bacteremia, parenteral nutrition, and chronic renal failure were variables independently associated with the development of candidemia. Multivariate logistic regression analysis of prognostic indicators showed that the independent variables associated with poor prognosis were inadequate initial therapy (P < .001) and high APACHE III score (P = .004). The inadequate initial therapy associated with mortality indicates the need for additional investigations to define high-risk patients for beneficial antifungal prophylaxis.
Bassetti
Matteo
M
Division of Infectious Diseases, S. Martino Hospital, University of Genoa School of Medicine, 16132 Genoa, Italy. mattba@tin.it
Trecarichi
Enrico Maria
EM
Righi
Elda
E
Sanguinetti
Maurizio
M
Bisio
Francesca
F
Posteraro
Brunella
B
Soro
Ornella
O
Cauda
Roberto
R
Viscoli
Claudio
C
Tumbarello
Mario
M
D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology; D002177:Candidiasis / Q000453:epidemiology*; D002405:Catheterization, Central Venous; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D025141:Drug Resistance, Fungal; D005260:Female; D016469:Fungemia / Q000453:epidemiology*; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications; D007902:Length of Stay; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D010288:Parenteral Nutrition; D012307:Risk Factors; D016896:Treatment Outcome
D000935:Antifungal Agents