Biofilm production by Candida species and inadequate antifungal therapy as predictors of mortality for patients with candidemia.
Nosocomial Candida bloodstream infections rank among infections with highest mortality rates. A retrospective cohort analysis was conducted at Catholic University Hospital to estimate the risk factors for mortality of patients with candidemia. We reviewed records for patients with a Candida bloodstream infection over a 5-year period (January 2000 through December 2004). Two hundred ninety-four patients (42.1% male; mean age +/- standard deviation, 65 +/- 12 years) were studied. Patients most commonly were admitted with a surgical diagnosis (162 patients [55.1%]), had a central venous catheter (213 [72.4%]), cancer (118 [40.1%]), or diabetes (58 [19.7%]). One hundred fifty-four (52.3%) patients died within 30 days. Of 294 patients, 168 (57.1%) were infected by Candida albicans, 64 (21.7%) by Candida parapsilosis, 28 (9.5%) by Candida tropicalis, and 26 (8.8%) by Candida glabrata. When fungal isolates were tested for biofilm formation capacity, biofilm production was most commonly observed for isolates of C. tropicalis (20 of 28 patients [71.4%]), followed by C. glabrata (6 of 26 [23.1%]), C. albicans (38 of 168 [22.6%]), and C. parapsilosis (14 of 64 [21.8%]). Multivariable analysis identified inadequate antifungal therapy (odds ratio [OR], 2.35; 95% confidence interval [95% CI], 1.09 to 5.10; P = 0.03), infection with overall biofilm-forming Candida species (OR, 2.33; 95% CI, 1.26 to 4.30; P = 0.007), and Acute Physiology and Chronic Health Evaluation III scores (OR, 1.03; 95% CI, 1.01 to 1.15; P < 0.001) as independent predictors of mortality. Notably, if mortality was analyzed according to the different biofilm-forming Candida species studied, only infections caused by C. albicans (P < 0.001) and C. parapsilosis (P = 0.003) correlated with increased mortality. Together with well-established factors, Candida biofilm production was therefore shown to be associated with greater mortality of patients with candidemia, probably by preventing complete organism eradication from the blood.
Tumbarello
Mario
M
Institute of Infectious Diseases, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy.
Posteraro
Brunella
B
Trecarichi
Enrico Maria
EM
Fiori
Barbara
B
Rossi
Marianna
M
Porta
Rosaria
R
de Gaetano Donati
Katleen
K
La Sorda
Marilena
M
Spanu
Teresa
T
Fadda
Giovanni
G
Cauda
Roberto
R
Sanguinetti
Maurizio
M
D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D018441:Biofilms / Q000187:drug effects / Q000254:growth & development*; D002175:Candida / Q000145:classification* / Q000187:drug effects / Q000254:growth & development*; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D005260:Female; D016469:Fungemia / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality*; D006785:Hospitals, University; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors
D000935:Antifungal Agents