title: Epidemiology and predictors of a poor outcome in elderly patients with candidemia.
abstract: BACKGROUND
  Candidemia affects patient populations from neonates to the elderly. Despite this, little information is available about the epidemiology of candidemia in elderly patients.
  
  
  METHODS
  We performed a retrospective analysis of 987 episodes of candidemia in adults (>14 years of age) from the databases of three laboratory-based surveys of candidemia performed at 14 tertiary care hospitals. Patients aged ≥60 years were considered elderly (group 1, n=455, 46%) and were compared to younger patients (group 2, n=532, 54%) regarding demographics, underlying diseases, comorbidities, exposure to medical procedures, species, treatment, and outcome.
  
  
  RESULTS
  The median APACHE II score was significantly higher in the elderly patients (19 vs. 15, p=0.03). Variables that were observed significantly more frequently in elderly patients included admission to an intensive care unit, diabetes mellitus, renal failure, cardiac disease, lung disease, receipt of antibiotics or H2 blockers, insertion of a central venous catheter, mechanical ventilation, and candidemia due to Candida tropicalis. The 30-day mortality of elderly patients was significantly higher than that of younger patients (70% vs. 45%, p<0.001). Factors associated with higher mortality by multivariate analysis included APACHE II score and being in group 1 (elderly). Factors associated with mortality in elderly patients were lung disease and the receipt of mechanical ventilation.
  
  
  CONCLUSIONS
  Elderly patients account for a substantial proportion of patients with candidemia and have a higher mortality compared to younger patients.
authors.affiliation: Universidade Federal de São Paulo, São Paulo, Brazil; Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil. tguimaraes@terra.com.br
authors.forename: Thaís
authors.initials: T
authors.lastname: Guimarães
authors.forename: Márcio
authors.initials: M
authors.lastname: Nucci
authors.forename: João S
authors.initials: JS
authors.lastname: Mendonça
authors.forename: Roberto
authors.initials: R
authors.lastname: Martinez
authors.forename: Ligia R
authors.initials: LR
authors.lastname: Brito
authors.forename: Nivia
authors.initials: N
authors.lastname: Silva
authors.forename: Maria Luiza
authors.initials: ML
authors.lastname: Moretti
authors.forename: Reinaldo
authors.initials: R
authors.lastname: Salomão
authors.forename: Arnaldo L
authors.initials: AL
authors.lastname: Colombo
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002175:Candida / Q000302:isolation & purification*; D058387:Candidemia / Q000382:microbiology / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult