title: Factors related to outcome of bloodstream infections due to Candida parapsilosis complex.
abstract: Although Candida albicans is the most common cause of fungal blood stream infections (BSIs), infections due to Candida species other than C. albicans are rising. Candida parapsilosis complex has emerged as an important fungal pathogen and became one of the main causes of fungemia in specific geographical areas. We analyzed the factors related to outcome of candidemia due to C. parapsilosis in a single tertiary referral hospital over a five-year period.
  
  
  
  A retrospective observational study of all cases of candidemia was carried out at a 980-bedded University Hospital in Italy. Data regarding demographic characteristics and clinical risk factors were collected from the patient's medical records. Antifungal susceptibility testing was performed and MIC results were interpreted according to CLSI species-specific clinical breakpoints.
  
  
  
  Of 270 patients diagnosed with Candida BSIs during the study period, 63 (23 %) were infected with isolates of C. parapsilosis complex which represented the second most frequently isolated yeast after C. albicans. The overall incidence rate was 0.4 episodes/1000 hospital admissions. All the strains were in vitro susceptible to all antifungal agents. The overall crude mortality at 30 days was 27 % (17/63), which was significantly lower than that reported for C. albicans BSIs (42 % [61/146], p = 0.042). Being hospitalized in ICU resulted independently associated with a significant higher risk of mortality (HR 4.625 [CI95% 1.015-21.080], p = 0.048). Conversely, early CVC removal was confirmed to be significantly associated with a lower risk of mortality (HR 0.299 [CI95% 0.102-0.874], p = 0.027). Finally, the type of primary antifungal therapy did not influence the outcome of infection.
  
  
  
  Candidemia due to C. parapsilosis complex, the second most commonly causative agent of yeast BSIs in our center, is characterized by a non-negligible mortality at 30 days. An early CVC removal is associated with a significant reduced mortality.
authors: Clinica Malattie Infettive; Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°- G.M. Lancisi - G. Salesi, Ancona, Italy. f.barchiesi@univpm.it.
authors: Francesco
authors: 0000-0003-1098-902X
authors: F
authors: Barchiesi
authors: Clinica Malattie Infettive; Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°- G.M. Lancisi - G. Salesi, Ancona, Italy.
authors: Elena
authors: E
authors: Orsetti
authors: Pediatria, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°- G.M. Lancisi - G. Salesi, Ancona, Italy.
authors: Patrizia
authors: P
authors: Osimani
authors: Clinica Pediatrica; Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°- G.M. Lancisi - G. Salesi, Ancona, Italy.
authors: Carlo
authors: C
authors: Catassi
authors: Anestesia e Rianimazione Pediatrica, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°- G.M. Lancisi - G. Salesi, Ancona, Italy.
authors: Fabio
authors: F
authors: Santelli
authors: Laboratorio di Microbiologia, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°- G.M. Lancisi - G. Salesi, Ancona, Italy.
authors: Esther
authors: E
authors: Manso
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity*; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013045:Species Specificity; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents
keywords: Antifungal agents; Candida paraspilosis complex; Candidemia; Mortality; Risk factors