The predictors of outcome in immunocompetent patients with hematogenous candidasis

Amar Safdar, Thomas W. Bannister, Zeenat Safdar

Research output: Contribution to journalArticle

28 Scopus citations

Abstract

Objective: Clinical parameters that predict outcome in non-immunosuppressed candidemic patients are not fully understood. Methods: Eighty-one consecutive episodes of candidemia were retrospectively evaluated in 75 patients during 1998-2000. Results: Infection due to Candida albicans was common (n = 30; 37%) followed by Candida glabrata (n = 25; 31%), Candida parapsilosis (n = 14; 17%), Candida tropicalis (n = 6; 7%), Candida krusei (n = 5; 6%), and Candida lusitaniae (n = 1; 1%). Among 70 evaluable patients, 31 (44%) had fungemia-associated mortality; advanced age (P < 0.004), underlying malignancy (P < 0.025), coronary artery disease (P < 0.01), and concurrent non-Candida species fungal infection (P < 0.047) were significant prognosticators of compromised Short-term survival by multivariate analysis. Mortality was higher in patients with Candida glabrata (60%) and C. tropicalis (75%) infection compared to 44% deaths in individuals with C. albicans infection (P>0.1). 11/25 (44%) of non-immunocompromised individuals died and 20/45 (44%) immunosuppressed patients succumbed to fungemia: persistent vs. non-persistent (<3 days) Candida blood-stream invasion, neutropenia, diabetes mellitus, renal insufficiency, prior antimicrobial therapy, cirrhosis of liver, abdomino-pelvis surgery, and critical-care-unit vs. non critical-care-unit admission did not significantly impact outcome in either group. All 11 infants, including nine with prematurity survived Candida species bloodstream infection (P < 0.025). Conclusions: Short-term mortality in candidemic non-immunocompromised patients was comparable to fungemia-associated deaths in immunosuppressed patients. Ischemic heart disease has appeared as a new predictor of unfavorable outcome in patients with hematogenous candidiasis.

Original languageEnglish (US)
Pages (from-to)180-186
Number of pages7
JournalInternational Journal of Infectious Diseases
Volume8
Issue number3
DOIs
StatePublished - May 2004

Keywords

  • Fungemia
  • Immunocompetent host
  • Immunosuppressed host
  • Ischemic heart disease
  • Non-albicans candidemia
  • Predictors of outcome

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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