title: Comparison of the clinical risk factors between Candida albicans and Candida non-albicans species for bloodstream infection.
abstract: The purpose of this study is to investigate the risk factors and susceptibilities to antifungal agents of Candida albicans and Candida non-albicans species (spp.) in candidemia cases in Kobe University Hospital. We investigated all consecutive patients with candida bloodstream infection (BSI) from 2008-2013 for whose full data were available for analyses, examining clinical factors such as gender, general complications, postoperative status or susceptibilities to antifungal agents. These factors were also compared between Candida albicans spp. and Candida non-albicans by univariate and multivariate analyses. Univariate analyses showed a significantly higher rate of Candida non-albicans species BSI patients cancer (odds ratio (OR) (95% confidence interval (CI))=2.29 (1.04-5.06) and P=0.040), chemotherapy (OR=4.35 (1.11-17.1) and P=0.035), fluconazole (FLCZ) resistance (OR=77.3 (4.51-1324) and P=0.003), and itraconazole (ITCZ) resistance (OR=15.6 (5.39-45.1) and P<0.001) and lower rate of underlying cardiovascular diseases (OR=0.27 (0.09-0.80) and P=0.018) and postoperative status (OR=0.35 (0.16-0.77) and P=0.035) in than Candida albicans. Multivariate analyses demonstrated that Candida non-albicans spp. had significantly higher rate of chemotherapy (OR=4.44 (1.04-19.0) and P=0.045), FLCZ resistance (OR=5.87 (2.01-17.1) and P=0.001), and ITCZ resistance (OR=18.7(5.77-60.4) and P<0.001) and lower rate of underlying cardiovascular diseases (OR=0.25 (0.08-0.82) and P=0.022) than Candida albicans. In conclusion, this study revealed several risk factors for BSI with Candida albicans (underlying cardiovascular diseases and postoperative status) and Candida non-albicans spp. (cancer and chemotherapy), and demonstrated that Candida non-albicans spp. were more resistant to FLCZ and ITCZ than Candida albicans.
authors.affiliation: 1] Division of Urology, Department of Organ Therapeutics, Kobe University Graduate School of Medicine, Kobe, Japan [2] Infection Control Team, Kobe University Hospital, Kobe, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Shigemura
authors.affiliation: Infection Control Team, Kobe University Hospital, Kobe, Japan.
authors.forename: Kayo
authors.initials: K
authors.lastname: Osawa
authors.affiliation: Infection Control Team, Kobe University Hospital, Kobe, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Jikimoto
authors.affiliation: Infection Control Team, Kobe University Hospital, Kobe, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshida
authors.affiliation: Division of Infectious Disease Therapeutics, Department of Microbiology and Infectious Diseases, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Brian
authors.initials: B
authors.lastname: Hayama
authors.affiliation: Division of Infectious Disease Therapeutics, Department of Microbiology and Infectious Diseases, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Goh
authors.initials: G
authors.lastname: Ohji
authors.affiliation: Division of Infectious Disease Therapeutics, Department of Microbiology and Infectious Diseases, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Iwata
authors.affiliation: Division of Urology, Department of Organ Therapeutics, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Fujisawa
authors.affiliation: 1] Division of Urology, Department of Organ Therapeutics, Kobe University Graduate School of Medicine, Kobe, Japan [2] Infection Control Team, Kobe University Hospital, Kobe, Japan.
authors.forename: Soichi
authors.initials: S
authors.lastname: Arakawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002175:Candida / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification*; D002176:Candida albicans / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification*; D058387:Candidemia / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D002318:Cardiovascular Diseases / Q000150:complications / Q000601:surgery; D025141:Drug Resistance, Fungal; D005260:Female; D015725:Fluconazole / Q000494:pharmacology / Q000627:therapeutic use; D006785:Hospitals, University; D006786:Hospitals, Urban; D006801:Humans; D017964:Itraconazole / Q000494:pharmacology / Q000627:therapeutic use; D007564:Japan / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents; D000970:Antineoplastic Agents; D017964:Itraconazole; D015725:Fluconazole