title: Predictors of candidaemia caused by non-albicans Candida species: results of a population-based surveillance in Barcelona, Spain.
abstract: Although Candida albicans (CA) is the most common cause of Candida bloodstream infections (BSIs), recent studies have observed an increasing percentage of candidaemias caused by non-albicans Candida species (NAC). In the present study, we attempted to identify the predictors of candidaemia due to NAC compared to CA. We analyzed data from an active population-based surveillance in Barcelona (Spain) from January 2002 to December 2003. Factors associated with NAC fungaemia were determined by multivariate analysis. A total of 339 episodes of Candida BSI, in 336 patients (median age 63 years, interquartile range: 41-72 years), were included. CA was the most commonly isolated (52%), followed by Candida parapsilosis (23%), Candida tropicalis (10%), Candida glabrata (8.6%), Candida krusei (3.4%) and other NAC spp. (3%).Overall, 48% of cases were due to NAC spp. Multivariate logistic regression analysis identified factors associated with a risk of BSI due to NAC spp.: having received a haematologic transplant (OR 10.8; 95% CI 1.31-90.01; p 0.027), previous fluconazole exposure (OR 4.47; 95% CI 2.12-9.43; p <0.001) and neonatal age (OR 4.42; 95% CI 1.63-12.04; p 0.004). Conversely, previous CA colonization (OR 0.33; 95% CI 0.19-0.57; p 0.001) and previous antibiotic use (OR 0.42; 95% CI 0.21-0.85; p 0.017) were associated with CA fungaemia compared to NAC. In conclusion, NAC candidaemia comprised 48% of cases in our series. Predictors of NAC include having received a haematologic transplant, neonatal age and previous fluconazole use.
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain. dolorodriguez@vhebron.net
authors.forename: D
authors.initials: D
authors.lastname: Rodríguez
authors.forename: B
authors.initials: B
authors.lastname: Almirante
authors.forename: M
authors.initials: M
authors.lastname: Cuenca-Estrella
authors.forename: J L
authors.initials: JL
authors.lastname: Rodríguez-Tudela
authors.forename: J
authors.initials: J
authors.lastname: Mensa
authors.forename: J
authors.initials: J
authors.lastname: Ayats
authors.forename: F
authors.initials: F
authors.lastname: Sanchez
authors.forename: A
authors.initials: A
authors.lastname: Pahissa
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage; D002175:Candida / Q000145:classification*; D058387:Candidemia / Q000453:epidemiology* / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D015725:Fluconazole / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012044:Regression Analysis; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D065227:Transfusion Reaction
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole