Blood stream infections by Candida glabrata and Candida krusei: a single-center experience.
OBJECTIVE
The increasing incidence of Candida glabrata and Candida krusei infections is a significant problem because they are generally more resistant to fluconazole. We compared the risk factors associated with C. glabrata and C. krusei fungemia with Candida albicans fungemia and examined the clinical manifestations and prognostic factors associated with candidemia.


METHODS
We retrospectively reviewed demographic data, risk factors, clinical manifestations, and outcomes associated with C. glabrata and C. krusei fungemia at a tertiary-care teaching hospital during a 10-years period from 1997 to 2006.


RESULTS
During the study period, there were 497 fungemia episodes. C. glabrata fungemia accounted for 23 episodes and C. krusei fungemia accounted for 8. Complete medical records were available for 27 of these episodes and form the basis of this study. Compared to 54 episodes of C. albicans fungemia, renal insufficiency and prior fluconazole prophylaxis were associated with development of C. glabrata or C. krusei fungemia. The overall mortality was 67%. The fungemia-related mortality of C. glabrata and C. krusei was higher than that of C. albicans (52 vs. 26%, p=0.021). Empirical antifungal therapy did not decrease the crude mortality. Multiple logistic regression analysis showed that high APACHE II scores, catheter maintenance, and shock were independently associated with an increased risk of death.


CONCLUSIONS
Renal insufficiency and prior fluconazole prophylaxis were associated with the development of C. glabrata or C. krusei fungemia. Fungemia-related mortality of C. glabrata or C. krusei was higher than that of C. albicans. Outcomes appeared to be related to catheter removal, APACHE II scores, and shock.
Choi
Hee Kyoung
HK
Department of Internal Medicine, AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Jeong
Su Jin
SJ
Lee
Han Sung
HS
Chin
Bum Sik
BS
Choi
Suk Hoon
SH
Han
Sang Hoon
SH
Kim
Myung Soo
MS
Kim
Chang Oh
CO
Choi
Jun Yong
JY
Song
Young Goo
YG
Kim
June Myung
JM
D018806:APACHE; D000328:Adult; D000368:Aged; D041221:Candida glabrata; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D016469:Fungemia / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
D015725:Fluconazole