title: Clinical and epidemiological characteristics and risk factors for mortality in patients with candidemia in hospitals from Bogotá, Colombia.
abstract: BACKGROUND
  Bloodstream infection by Candida species has a high mortality in Latin American countries. The aim of this study was to describe the characteristics of patients with documented bloodstream infections caused by Candida species in third level hospitals and determine the risk factors for in-hospital-mortality.
  
  
  METHODS
  Patients from seven tertiary-care hospitals in Bogotá, Colombia, with isolation of a Candida species from a blood culture were followed prospectively from March 2008 to March 2009. Epidemiologic information, risk factors, and mortality were prospectively collected. Isolates were sent to a reference center, and fluconazole susceptibility was tested by agar-based E-test. The results of susceptibility were compared by using 2008 and 2012 breakpoints. A multivariate analysis was used to determinate risk factors for mortality.
  
  
  RESULTS
  We identified 131 patients, with a median age of 41.2 years. Isolates were most frequently found in the intensive care unit (ICU). Candida albicans was the most prevalent species (66.4% of the isolates), followed by C. parapsilosis (14%). Fluconazole resistance was found in 3.2% and 17.6% of the isolates according to the 2008 and 2012 breakpoints, respectively. Fluconazole was used as empirical antifungal therapy in 68.8% of the cases, and amphotericin B in 22%. Hospital crude mortality rate was 35.9%. Mortality was associated with age and the presence of shock at the time of Candida detection. Fluconazole therapy was a protective factor for mortality.
  
  
  CONCLUSIONS
  Candidemia is associated with a high mortality rate. Age and shock increase mortality, while the use of fluconazole was shown to be a protective factor. A higher resistance rate with new breakpoints was noted.
authors.affiliation: Department of Internal Medicine, Universidad Nacional de Colombia, Bogota, Colombia; Infectious Diseases Research Group, Universidad Nacional de Colombia, Bogota, Colombia. Electronic address: jacortesl@unal.edu.co.
authors.forename: Jorge Alberto
authors.initials: JA
authors.lastname: Cortés
authors.affiliation: Department of Internal Medicine, Universidad Nacional de Colombia, Bogota, Colombia.
authors.forename: Patricia
authors.initials: P
authors.lastname: Reyes
authors.affiliation: Department of Internal Medicine, Universidad Nacional de Colombia, Bogota, Colombia.
authors.forename: Carlos Hernando
authors.initials: CH
authors.lastname: Gómez
authors.affiliation: Department of Internal Medicine, Universidad Nacional de Colombia, Bogota, Colombia; Infectology Group, Instituto Nacional de Cancerología, Bogota, Colombia; Grupo de investigación en enfermedades infecciosas en cáncer y alteraciones hematológicas (GREICAH), Bogota, Colombia.
authors.forename: Sonia Isabel
authors.initials: SI
authors.lastname: Cuervo
authors.affiliation: Department of Microbiology, Universidad Nacional de Colombia, Bogota, Colombia.
authors.forename: Pilar
authors.initials: P
authors.lastname: Rivas
authors.affiliation: Department of Internal Medicine, Universidad Nacional de Colombia, Bogota, Colombia.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Casas
authors.affiliation: Psychiatry Department, Universidad Nacional de Colombia, Bogota, Colombia.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Sánchez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology; D002175:Candida / Q000145:classification* / Q000187:drug effects; D058387:Candidemia / Q000382:microbiology / Q000401:mortality*; D002648:Child; D003105:Colombia / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Candida; Candidemia; Candidemia/epidemiology; Candidemia/mortality; Candidemia/therapy; Colombia; Fluconazole