title: Epidemiology and prognostic factors of candidemia in elderly patients.
abstract: OBJECTIVE
  The present retrospective study was carried out to investigate the epidemiological characteristics and the prognostic factors of candidemia among elderly patients.
  
  
  METHODS
  From 2009 to 2012, elderly patients with candidemia were identified at the Chi Mei medical center, a 900-bed regional hospital in southern Taiwan, and their medical records retrospectively reviewed.
  
  
  RESULTS
  During the 4-year period, a total of 175 episodes of candidemia among elderly patients were identified. The patients ranged in age from 65 to 98 years (mean 76.4 years) and the mean (±standard deviation) Charlson Comorbidity Index score was 7.6 (±2.7). Cancer was the most common underlying disease (n = 127, 72.6%), followed by diabetes mellitus (n = 69, 39.4%). Candida albicans (n = 96, 54.9%) was the most common pathogen, followed by C. tropicalis (n = 39, 22.3%), C. parapsilosis (n = 24, 13.7%), C. glabrata (n = 22, 12.6%), C. guilliermondii (n = 2, 1.1%) and Candida species (n = 3, 1.7%). The ratio of C. albicans causing candidemia was significantly higher in young-old than old-old patients (64.1% vs 47.4%, P = 0.027). The overall in-hospital mortality was 50.3%. Multivariate analysis showed that the in-hospital mortality was only significantly associated with jaundice (P = 0.004), no use of antifungal agent (P = 0.021) and intensive care unit admission (P < 0.001).
  
  
  CONCLUSIONS
  Candidemia can develop in elderly patients, especially patients with cancer or other risk factors. C. albicans is the most common Candida species causing candidemia among elderly patients, followed by C. tropicalis. The mortality of candidemia among elderly patients remains high.
authors.affiliation: Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan.|Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
authors.forename: Hung-Jen
authors.initials: HJ
authors.lastname: Tang
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
authors.forename: Wei-Lun
authors.initials: WL
authors.lastname: Liu
authors.affiliation: Department of Nursing, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
authors.forename: Hsin-Lan
authors.initials: HL
authors.lastname: Lin
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Lai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D041022:Candida tropicalis; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole
keywords: Candida albicans; cancer; candidemia; elderly; outcome