Nosocomial candidemia at a general hospital: prognostic factors and impact of early empiric treatment on outcome (2002-2005).
OBJECTIVE
To evaluate epidemiological and clinical prognosis factors related to mortality and impact of early empiric treatment on patients with nosocomial candidemia (NC).


METHODS
Observational study of a cohort of 107 adult patients with NC admitted at a tertiary hospital (2002-5).


RESULTS
In bivariate analysis, risk factors significantly associated with mortality rate (49.5%) were: age >65 years, previous steroid treatment, solid organ transplant, acute severity of illness, shock, renal failure and respiratory distress at onset, delayed or inadequate antifungal treatment, non-removal of central venous catheter and associated post-surgical bacterial sepsis or respiratory infection. In multivariate analysis, risk factor associated with mortality was acute severity of illness at onset (OR 76.9; CI 12.5-500) being early and adequate treatment (OR 11.8; CI 1.7-81.2) and early (<48h) removing of central venous catheter (OR 12.2; CI 1.9-74.9) factors associated with cure; there was no statistically significant difference between fungistatic (azoles) or fungicidal (amphotericin or caspofungin) treatment.


CONCLUSIONS
Acute severity of illness at onset is associated with mortality in patients with NC whereas early and adequate treatment and early removing of central venous catheter are associated with cure.
Gómez
Joaquín
J
Internal Medicine-Infectious Diseases Department, University Hospital Virgen de la Arrixaca, Murcia, España.
García-Vázquez
Elisa
E
Espinosa
Cristina
C
Ruiz
Joaquín
J
Canteras
Manuel
M
Hernández-Torres
Alicia
A
Baños
Victor
V
Herrero
José Antonio
JA
Valdés
Mariano
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002177:Candidiasis / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D016469:Fungemia / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D055815:Young Adult