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. 2025 May 20;7(3):dlaf078.
doi: 10.1093/jacamr/dlaf078. eCollection 2025 Jun.

Pitt candidaemia score as an assessment tool for mortality in patients with candidaemia caused by Candida tropicalis and other Candida species: a multicentre study conducted in Japan

Takashi Ueda  1 , Hiroshi Kakeya  2 , Koichiro Yoshida  3 , Akihiro Hisato  3 , Akira Ukimura  4   5 , Taku Ogawa  6 , Kazuhiko Nakajima  1 , Kosuke Iijima  7 , Miki Nagao  8 , Yasuhiro Tsuchido  8 , Hideki Kawamura  9 , Akari Shigemi  10 , Muneki Hotomi  11 , Masamitsu Kono  11 , Kei Kasahara  12 , Natsuko Imakita  12 , Yukihiro Kaneko  13 , Makoto Niki  14 , Koichi Yamada  2 , Shigeki Kakuno  2 , Taiga Miyazaki  15 , Makoto Sumiyoshi  15 , Yasushi Murakami  16 , Miki Doi  17 , Mutsunobu Yoshioka  18 , Yoshitsugu Miyazaki  19 , Yoshio Takesue  1   20
Affiliations

Pitt candidaemia score as an assessment tool for mortality in patients with candidaemia caused by Candida tropicalis and other Candida species: a multicentre study conducted in Japan

Takashi Ueda et al. JAC Antimicrob Resist. .

Erratum in

Abstract

Background: A bedside scoring system to assess the severity of disease is lacking for candidaemia. The Pitt candidaemia score (PCS) was evaluated for its association with mortality.

Methods: The PCS consists of five components, namely dialysis, hypotension, mechanical ventilation, cardiac arrest and mental status. Patients were classified into four categories according to their PCS. The correlation between PCS category at blood culture collection and 30 day mortality was studied individually for five Candida species.

Results: Leading rates of mortality were observed in Candida tropicalis and Candida krusei. The interval from inoculation to positive culture was 19.4 ± 9.7 h for C. tropicalis and 21.3 ± 5.6 h for C. krusei; these intervals were significantly shorter than those for other Candida species. In a Kaplan-Meier survival curve, a significant risk stratification by PCS category was demonstrated in all Candida species. A high PCS was an independent risk factor for mortality, and source control decreased the risk for C. tropicalis and Candida glabrata infections. Regarding antifungal therapy, the median PCS was 8 for liposomal amphotericin B, 2 for echinocandins and 0 for azoles, and this trend was consistent among four Candida species.

Conclusions: The mortality rate was well stratified by the PCS, and the PCS affected the selection of antifungals. A future prospective study is required for the PCS in guiding therapy for candidaemia.

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Figures

Figure 1.
Figure 1.
Flow chart for patient selection. (a) Multicentre study, (b) single-centre study. aBecause of combination therapy, diagnosis of ocular disease at the time of antifungal initiation or preceding antifungal therapy within 1 month.
Figure 2.
Figure 2.
The 30 day and early (within 14 days) mortality rates in patients with candidaemia, as determined in a multicentre study.
Figure 3.
Figure 3.
The 30 day mortality rate stratified by the four categories of PCS in patients with candidaemia caused by each Candida species. The 30 day mortality rate increased incrementally with higher PCS risk categories for C. tropicalis (P < 0.001), C. glabrata (P < 0.001), C. krusei (P < 0.013), C. albicans (P = 0.004) and C. parapsilosis (P = 0.002).
Figure 4.
Figure 4.
Kaplan–Meier survival curve for patients with candidaemia caused by all Candida species and each Candida species individually, stratified by the PCS. PCS 0, 1 = category 1; PCS 2, 3 = category 2; PCS 4–7 = category 3; PCS ≥8 = category 4. Multicentre study: (a) C. tropicalis, (b) C. glabrata, (c) C. krusei. Single-centre study: (a) C. albicans, (b) C. parapsilosis.
Figure 4.
Figure 4.
Kaplan–Meier survival curve for patients with candidaemia caused by all Candida species and each Candida species individually, stratified by the PCS. PCS 0, 1 = category 1; PCS 2, 3 = category 2; PCS 4–7 = category 3; PCS ≥8 = category 4. Multicentre study: (a) C. tropicalis, (b) C. glabrata, (c) C. krusei. Single-centre study: (a) C. albicans, (b) C. parapsilosis.
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