title: Risk factors for candidemia with non-albicans Candida spp. in intensive care unit patients with end-stage renal disease on chronic hemodialysis.
abstract: OBJECTIVE
  The objective of this study was to describe factors associated with bloodstream infections (BSIs) with non-albicans Candida species (NAC), compared with Candida albicans BSIs, and antifungal susceptibility patterns in adult intensive care unit (ICU) patients with chronic renal failure undergoing hemodialysis. To the best of our knowledge, this is the first study to report the potential factors for NAC candidemia in ICU patients with end-stage renal disease on chronic hemodialysis.
  
  
  METHODS
  This prospective, observational, multicenter study was conducted in the two centers of Baskent University between January 2007 and July 2010. All adult patients excluding patients with neutropenia, malignancy, glucocorticoid treatment or AIDS, were included.
  
  
  RESULTS
  Sixty cases (58.8%) of candidemia were due to C. albicans and 42 (41.2%) to NAC. Multivariate regression analysis revealed that the presence of a central venous catheter was the only risk factor independently associated with BSI due to NAC (p=0.046, odds ratio: 5.90, 95% confidence interval: 1.032-33.717). Mortality was more frequent in those with NAC than C. albicans BSIs (64.3% vs. 55%), but the difference was not significant (p=0.067). Except for two Candida glabrata strains, which were dose-dependently fluconazole susceptible, all Candida species were susceptible to fluconazole, caspofungin, voriconazole and amphotericin B.
  
  
  CONCLUSIONS
  Central venous catheterization was the only factor significantly associated with BSI due to NAC in ICU patients with end-stage renal disease.
authors: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Baskent University, TR 06490, Ankara, Turkey. kivanc1972@gmail.com
authors: Kivanc
authors: K
authors: Serefhanoglu
authors: Funda
authors: F
authors: Timurkaynak
authors: Fusun
authors: F
authors: Can
authors: Unal
authors: U
authors: Cagir
authors: Hande
authors: H
authors: Arslan
authors: F Nurhan
authors: FN
authors: Ozdemir
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification; D002176:Candida albicans / Q000187:drug effects / Q000302:isolation & purification; D058387:Candidemia / Q000209:etiology* / Q000382:microbiology / Q000401:mortality; D055499:Catheter-Related Infections / Q000209:etiology* / Q000382:microbiology / Q000401:mortality; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003428:Cross Infection / Q000209:etiology* / Q000382:microbiology / Q000401:mortality; D025141:Drug Resistance, Fungal; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000935:Antifungal Agents