title: Clinical characteristics and predictors of mortality in cirrhotic patients with candidemia and intra-abdominal candidiasis: a multicenter study.
abstract: OBJECTIVE
  The aim of the study was to describe the characteristics of cirrhotic patients with candidemia and intra-abdominal candidiasis (IAC) and to evaluate the risk factors associated with 30-day mortality.
  
  
  METHODS
  A multicenter multinational retrospective study including all consecutive episodes of candidemia and IAC in adult patients with liver cirrhosis in 14 European hospitals during the period 2011-2013 was performed.
  
  
  RESULTS
  A total of 241 episodes (169 candidemia, 72 IAC) were included. Most Candida infections were acquired in hospital (208, 86.3%), mainly in the intensive care unit (ICU) (121, 50.2%). At clinical presentation, fever was seen in 60.6% of episodes (146/241) and septic shock in 34.9% (84/241). C. albicans was the most common species (found in 131 episodes, 54.4%), followed by C. glabrata (35, 14.5%) and C. parapsilosis (34, 14.1%). Overall, the 30-day mortality was 35.3%. Multivariable analysis identified candidemia (OR 2.2, 95% CI 1.2-4.5) and septic shock (OR 3.2, 95% CI 1.7-6) as independent factors associated with 30-day mortality. Adequate antifungal treatment (OR 0.4, 95% CI 0.3-0.9) was associated with survival benefit.
  
  
  CONCLUSIONS
  A shift towards increasing prevalence of C. glabrata and C. parapsilosis species in patients with liver disease was documented. Candidemia and IAC were associated with significant mortality in cirrhotic patients. Thirty-day mortality was associated with candidemia and severe clinical presentation, whereas adequate antifungal treatment improved the prognosis.
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital and University of Udine, Piazzale S. Maria della Misericordia, n. 15, 33100, Udine, Italy. mattba@tin.it.
authors.forename: Matteo
authors.identifier: http://orcid.org/0000-0002-4406-962X
authors.initials: M
authors.lastname: Bassetti
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital and University of Udine, Piazzale S. Maria della Misericordia, n. 15, 33100, Udine, Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Peghin
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital and University of Udine, Piazzale S. Maria della Misericordia, n. 15, 33100, Udine, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Carnelutti
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital and University of Udine, Piazzale S. Maria della Misericordia, n. 15, 33100, Udine, Italy.
authors.forename: Elda
authors.initials: E
authors.lastname: Righi
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital and University of Udine, Piazzale S. Maria della Misericordia, n. 15, 33100, Udine, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Merelli
authors.affiliation: IRCCS AOU San Martino-IST, Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Ansaldi
authors.affiliation: IRCCS AOU San Martino-IST, Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Trucchi
authors.affiliation: IRCCS AOU San Martino-IST, Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Alicino
authors.affiliation: Microbiology Unit, Santa Maria Misericordia University Hospital, Udine, Italy.
authors.forename: Assunta
authors.initials: A
authors.lastname: Sartor
authors.affiliation: Department of Experimental and Clinical Medicine, University of Udine, Udine, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Toniutto
authors.affiliation: Medical Intensive Care Unit, University Hospitals Leuven, Department of Microbiology and Immunology, Laboratory for Clinical Infectious and Inflammatory Diseases, University of Leuven, Leuven, Belgium.
authors.forename: Joost
authors.initials: J
authors.lastname: Wauters
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Laleman
authors.affiliation: First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Napoli, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Tascini
authors.affiliation: Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Menichetti
authors.affiliation: Infectious Disease Unit, University Hospital of Trieste, Trieste, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Luzzati
authors.affiliation: Infectious Diseases Department, Ospedale Civile "SS. Giovanni e Paolo", Venice, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Brugnaro
authors.affiliation: Infectious Disease Clinic, IRCCS San Martino - IST Hospital, Genoa, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Mesini
authors.affiliation: Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Raviolo
authors.affiliation: Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
authors.forename: Francesco G
authors.initials: FG
authors.lastname: De Rosa
authors.affiliation: Critical Care, Hospital Vall d'Hebron, Institut de Recerca Vall d'Hebron-UAB, CIBERES, Barcelona, Spain.
authors.forename: Leonel
authors.initials: L
authors.lastname: Lagunes
authors.affiliation: Critical Care, Hospital Vall d'Hebron, Institut de Recerca Vall d'Hebron-UAB, CIBERES, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.affiliation: Department of Critical Care Medicine, Medical School, University of Athens, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Dimopoulos
authors.affiliation: University Hospital, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Arnaldo L
authors.initials: AL
authors.lastname: Colombo
authors.affiliation: University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Marcio
authors.initials: M
authors.lastname: Nucci
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Vena
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.affiliation: Institute of Microbiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Tumbarello
authors.affiliation: Institute of Microbiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Losito
authors.affiliation: Clinica Malattie Infettive, Università degli Studi di Udine, Azienda Sanitaria Universitaria Integrata, Presidio Ospedaliero "Santa Maria della Misericordia", Piazzale S. Maria della Misericordia n. 15, 33100, Udine, Italy.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Martin-Loeches
authors.affiliation: Infectious Disease Clinic, IRCCS San Martino - IST Hospital, Genoa, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Viscoli
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000302:isolation & purification; D058387:Candidemia / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D015897:Comorbidity; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D054714:Echinocandins / Q000627:therapeutic use; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D059413:Intraabdominal Infections / Q000188:drug therapy / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D013997:Time Factors
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins
keywords: Candida; Candidemia; Cirrhosis; Intra-abdominal candidiasis; Invasive candidiasis