title: Nosocomial candidemia at a general hospital: prognostic factors and impact of early empiric treatment on outcome (2002-2005).
abstract: 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.
authors.affiliation: Internal Medicine-Infectious Diseases Department, University Hospital Virgen de la Arrixaca, Murcia, España.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Gómez
authors.forename: Elisa
authors.initials: E
authors.lastname: García-Vázquez
authors.forename: Cristina
authors.initials: C
authors.lastname: Espinosa
authors.forename: Joaquín
authors.initials: J
authors.lastname: Ruiz
authors.forename: Manuel
authors.initials: M
authors.lastname: Canteras
authors.forename: Alicia
authors.initials: A
authors.lastname: Hernández-Torres
authors.forename: Victor
authors.initials: V
authors.lastname: Baños
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Herrero
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés
mesh_terms: 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