Risk factors for candidemia-related mortality at a medical center in central Taiwan

Abstract

Background and purpose: Bloodstream infections due to Candida spp. are associated with significant mortality and morbidity. This study analysed the epidemiology and outcome of candidemia cases in a teaching hospital in central Taiwan.

Methods: We retrospectively studied the clinical characteristics and antifungal susceptibility of isolates and risk factors for mortality in 91 cases of candidemia treated from January 1, 2001 to June 30, 2003.

Results: The mean age of the patients was 67 years (range, 30-90 years). Three episodes (3%) were community acquired. Adequate antifungal therapy was given to 78 patients (78%). Cancer (38.5%) and diabetes mellitus (36.3%) were the 2 most common underlying diseases. The most frequent risk factors identified for candidemia were prior broad-spectrum antibiotic use (84.6%), central venous catheterization (83.5%) and Candida colonization (79.5%). The most frequent isolates were Candida albicans (64.8%) and Candida tropicalis (19.8%). All of the C. albicans and C. tropicalis isolates were sensitive to fluconazole (minimal inhibitory concentration <or=8 microg/mL). Susceptibility to amphotericin B and fluconazole was found in 96.7% (88/91) and 95.6% (87/91) of Candida spp., respectively. Risk factors for mortality due to candidemia in the univariate analysis included central venous catheterization, shock, and high Acute Physiology and Chronic Health Evaluation II (APACHE II) score. APACHE II score was the only independent prognostic factor in the multivariate analysis.

Conclusions: Candidemia has a high mortality rate and C. albicans remains the most common isolate. Fluconazole and amphotericin B maintained good in vitro antifungal activity against Candida spp. APACHE II score was the only independent factor for mortality in patients with candidemia.