title: Clinical significance of time to positivity for yeast in candidemia.
abstract: OBJECTIVE
  Candidemia is an important issue of nosocomial bloodstream infections, and is associated with a high mortality rate. However, little information is available before final species identification, which takes days after the episode of candidemia. This study tried to determine whether time to positivity (TTP) for yeast helps in predicting the species of candidemia.
  
  
  METHODS
  A retrospective cohort study was conducted in Taiwan, which included 434 episodes of nonduplicated candidemia during the period between 2006 and 2009. The demographic features, clinical characteristics, TTP for yeast, and acute illness scores were included for analysis.
  
  
  RESULTS
  The mean age of patients with candidemia was 70.4 ± 15.2 years, and the 30-day crude mortality rate was 48.2%. Forty-five percent of patients suffered from shock status with a mean Acute Physiological and Chronic Health Evaluation II score of 27.0 ± 8.7 and a mean Sequential Organ Failure Assessment score of 9.7 ± 4.5, whereas 50% were admitted to the intensive care units. Candida albicans was still the most commonly identified pathogen (58.1%), followed by C. tropicalis (14.7%), C. parapsilosis (13.1%), and C. glabrata (8.3%). Results of multivariate logistic regression showed that TTP for yeast within 48 hours would more favor C. tropicalis (p = 0.044), and less favor C. glabrata (p = 0.025) and C. parapsilosis (p < 0.001). Patients with parenteral nutrition usage were more frequently associated with a TTP for yeast within 48 hours, whereas those with previous exposure to an antifungal agent had a longer TTP for yeast.
  
  
  CONCLUSIONS
  The TTP for yeast might provide a hint of the responsible Candida species before final identification among critical patients with candidemia. The association between antifungal agents and TTP would need more evidence for elucidation.
authors.affiliation: Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Liang-Yu
authors.initials: LY
authors.lastname: Chen
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Infectious Disease, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Su-Pen
authors.initials: SP
authors.lastname: Yang
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Infectious Disease, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Te-Li
authors.initials: TL
authors.lastname: Chen
authors.affiliation: Division of Infection Control, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Shu-Yuan
authors.initials: SY
authors.lastname: Liao
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Infection Control, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Yin-Yin
authors.initials: YY
authors.lastname: Chen
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Division of Virology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Yu-Jiun
authors.initials: YJ
authors.lastname: Chan
authors.affiliation: Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Liang-Kung
authors.initials: LK
authors.lastname: Chen
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Infectious Disease, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Infection Control, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: fdwang@vghtpe.gov.tw.
authors.forename: Fu-Der
authors.initials: FD
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001769:Blood / Q000382:microbiology*; D002175:Candida / Q000145:classification* / Q000302:isolation & purification*; D058387:Candidemia / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013624:Taiwan; D013997:Time Factors; D055815:Young Adult
keywords: Antifungal treatment; Candidemia; Time to positivity