title: Blood stream infections by Candida glabrata and Candida krusei: a single-center experience.
abstract: 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.
authors.affiliation: Department of Internal Medicine, AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hee Kyoung
authors.initials: HK
authors.lastname: Choi
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Jeong
authors.forename: Han Sung
authors.initials: HS
authors.lastname: Lee
authors.forename: Bum Sik
authors.initials: BS
authors.lastname: Chin
authors.forename: Suk Hoon
authors.initials: SH
authors.lastname: Choi
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Han
authors.forename: Myung Soo
authors.initials: MS
authors.lastname: Kim
authors.forename: Chang Oh
authors.initials: CO
authors.lastname: Kim
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Choi
authors.forename: Young Goo
authors.initials: YG
authors.lastname: Song
authors.forename: June Myung
authors.initials: JM
authors.lastname: Kim
mesh_terms: 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
chemical_list: D015725:Fluconazole