Clinical and microbiological factors associated with mortality in candidemia in adult patients 2007–2016

Abstract

Background: Candidemia is a life-threatening infection with high mortality. Our aim was to evaluate the Candida species distribution, antifungal susceptibilities and risk factors associated with 30-day mortality in candidemia in Southern Finland.

Methods: We present a retrospective analysis of candidemia cases from the hospital district of Helsinki and Uusimaa during 2007–2016. Patients younger than 18 years old were excluded. A total of 386 candida isolates from 374 episodes of candidemia were identified in 350 adult patients.

Results: Candida albicans was the leading cause of candidemia (60.4%), followed by C. glabrata (21.5%), C. parapsilosis (5.2%) and C. dubliniensis (5.2%). There was no statistically significant change in the distribution of C. albicans vs non-albicans species during the study period. Thirty-day overall mortality was 30.7%. When patients who received no antifungal treatment were excluded from the mortality analysis, 30-day mortality was 23.0%. Severity of underlying illnesses (OR 20.55, 95% CI 5.98–70.60), ICU stay at the onset of candidemia (OR 5.06, 95% CI 1.75–14.68) and age >65 years (OR 3.98, 95% CI 1.97–8.02) were independent risk factors of 30-day mortality in multivariable analysis. However, there was no statistically significant association between 30-day mortality and an early start of an effective antifungal.

Conclusion: There was not a significant shift to non-albicans species as the cause of candidemia in Southern Finland during the 10-year study period. Furthermore, we did not find an association between 30-day mortality and the early start of an antifungal treatment. Comorbidity considerably increased the risk of fatal outcome.

Keywords:

• Candidemia
• species distribution
• 30-day mortality
• risk factors
• early start of treatment

Disclosure statement

Potential conflicts of interest outside this article (none for this article): MAH has received a lecture fee from MSD, a conference invitation from Pfizer and MSD. VJA has received a lecture fee from Pfizer, MSD, Astellas, Unimedic, Roche, BMS and Biogen; has participated as PI to Varicella zoster vaccination studies; and has received a study grant for pneumococcal vaccination study. MV, EK and NF declare that they have no conflict of interest.

Additional information

Funding

This study was funded by the Orion Research Foundation sr and the Finnish Society for Study of Infectious Diseases, and has received financial support also from Helsinki University Hospital [EVO grant TYH2016105].