Mortality in patients with early- or late-onset candidaemia

Abstract

Objectives: Although candidaemia is a well-known complication of hospital stay and has a crude mortality of ∼40%, few data are available for episodes diagnosed within 10 days after hospital admission. In this paper, we compared the risk factors for mortality according to the onset of candidaemia.

Methods: This was a retrospective study of hospitalized patients with early-onset candidaemia (EOC; ≤ 10 days) or late-onset candidaemia (LOC; >10 days) to identify any distinct clinical characteristics and risk factors for 30 day mortality in two Italian academic centres.

Results: A total of 779 patients were included in the study: 183 EOC and 596 LOC. Mortality was significantly lower in EOC (71/183, 38.8% versus 283/596, 47.5%, P=0.03). In EOC, multivariate analysis showed that inadequate initial antifungal therapy (IIAT) (P=0.005, OR 3.02, 95% CI 1.40-6.51), Candida albicans aetiology (P=0.02, OR 2.17, 95% CI 1.11-4.26) and older age (P<0.001, OR 1.05, 95% CI 1.02-1.07) were independent risk factors for mortality. In LOC, liver disease (P=0.003, OR 2.46, 95% CI 1.36-4.43), IIAT (P=0.002, OR 2.01, 95% CI 1.28-3.15) and older age (P<0.001, OR 1.03, 95% CI 1.02-1.04) were independently associated with a fatal outcome, while treatment with caspofungin was associated with survival (P<0.001, OR 0.42, 95% CI 0.26-0.67).

Conclusions: EOC has different clinical characteristics and risk factors for mortality compared with LOC. Although EOC mortality is significantly lower, the rate of inappropriate antifungal treatment is higher. Treatment with caspofungin is significantly associated with survival in patients with LOC. Efforts are needed to improve the diagnosis and treatment of EOC.

Figure 1.

Distribution of yeast species isolated at the Agostino Gemelli University Hospital (UCSC) and San Giovanni Battista University Hospital (MSGB). Polyfungal: 27 blood culture samples yielded two different Candida spp., including C. albicans/C. parapsilosis (n = 9), C. albicans/C. glabrata (n = 6), C. albicans/C. tropicalis (n = 5), C. albicans/Candida guilliermondii (n = 2), C. glabrata/C. tropicalis (n = 2), C. glabrata/C. parapsilosis (n = 1), C. parapsilosis/C. tropicalis (n = 1) and C. parapsilosis/C. guilliermondii (n = 1). Other species include Candida lusitaniae, Candida lambica, Candida famata and Blastoschizomyces capitatus.