Clinical presentation of candidaemia in elderly patients: experience in a single institution

Abstract

Objective: To analyse the clinical presentation of candidaemia in elderly patients.

Methods: A comparison of clinical presentation of candidaemia cases was carried out in a Spanish tertiary hospital between January 2010 and September 2015.

Results: Forty-five cases (32%) corresponded to elderly patients (≥ 75 years) and 95 cases (68%) to non-elderly patients (16-74 years). A higher proportion of elderly patients presented solid tumour (51% versus 32%, p=0.026) and a lower proportion had undergone solid or hematopoietic transplantation (0% versus 28%, p<0.001). Fewer elderly patients (16 patients, 36%) had a central venous line inserted than non-elderly patients (81 patients, 85%, p<0.001). Isolation of Candida parapsilosis was significantly lower among elderly (13.3%) than among non-elderly patients (32%, p=0.015). Fundoscopy was carried out in 20 elderly (44%) and in 64 younger patients (67%, p=0.009). The proportion of patients who underwent echocardiography was similar in both groups (56% vs 66%, respectively; p=0.218). Adequate antifungal treatment within the first 48 hours was administered in16 elderly patients (36%) and 58 younger patients (61%, p=0.005). Catheter removal was carried out in 9 elderly patients (68.1%) and in 40 non-elderly patients (49%, p=0.544). Mortality was higher among elderly patients (55.6%) than non-elderly patients (36.8%; p=0.037).

Conclusions: Elderly patients account for a substantial proportion of patients suffering from candidaemia in recent years. The clinical management of these patients was less appropriate than in younger patients with respect to fundus examination and the prescription of appropriate antifungal treatment. Mortality in elderly patients was higher than in younger patients.