The impact of age on risk assessment, therapeutic practice and outcome in candidemia

Abstract

Background: In Norway, the epidemiological situation of candidemia is followed closely. We have previously demonstrated the highest incidence of candidemia in elderly >65 years of age. However, knowledge of other aspects of this infection is lacking.

Objective: The aim of this nationwide, retrospective study was to examine risk factors, therapeutic practice and outcome in adult candidemia patients according to age.

Methods: We retrieved data from medical records from patients who developed candidemia in Norway between 1 January 2008 and 31 December 2012. Data were analyzed according to age, younger patients being between 18 and 65 years, elderly being ≥65 years of age.

Results: From 771 eligible patients, 738 patients (95.7%) were included (58% men, mean age 65.2 years, 58.1% being ≥65 years). Exposure to health-care related risk factors for candidemia were significantly more common in the younger patients (neutropenia, central venous catheter, mechanical ventilation and chemotherapy) who received empirical treatment more often than the elderly (29.8% vs. 21.7%, p = .01). More elderly did not received any antifungal therapy (27.3% vs 16.8%, p < 0001) and had higher mortality compared to younger patients (45.5% vs 23.9%, p < .0001). In the study population, mortality was higher with age (per 10-years increase, OR 1.43;1.28–1.59, p < 0.0001), in patients not receiving targeted therapy (OR 2.5; CI 1.82–3.36, p < .0001) or any therapy at all (OR 4.64; 3.23-6.68, p < .0001).

Conclusions: Risk factors for candidemia, treatment and outcome differed significantly according to age. Given the increasing numbers of elderly, scrutiny on our clinical practice is warranted.

Keywords:

• Candidemia
• risk factors
• elderly
• targeted treatment
• 30-day mortality

Acknowledgements

The authors thank the Norwegian Fungal Network for their major contribution in data collection including Dag Torfoss (Oslo University Hospital, DNR) , Karianne W. Gammelsrud (Oslo University Hospital, Ullevål), A. Kanestrøm, Jetmund Ringstad (Østfold Hospital, Kalnes), Carola Grub, Rolf Arne Sandnes, Ivar Jo Hagen (Innlandet Hospital, Lillehammer), K. Schiøtz (Innlandet Hospital, Gjøvik), Annette Onken, Pål Jenum, Else Johanne Rønning (Vestre Viken, Baerum Hospital), Thomas Skrede (Vestre Viken, Drammen Hospital), Dagfinn Skaare (Vestfold Hospital, Tønsberg), Yngvar Tveten, Hilde Skudal (Telemark Hospital, Skien), Ståle Tofteland, Liv Ragnhild Høyvoll (Sørlandet Hospital, Kristiansand), Reidar Hjetland (Førde Hospital), Reidar Hide, Solvor Fuglestad, Jørn Åge Longva (Ålesund Hospital), Angela Kümmel (Levanger Hospital), Sandra Åsheim, Gunille Justad Sundnes (Nordlandssykehuset, Bodø), Nicola Isabelle Kols (University Hospital of Northern Norway)

Disclosure statement

The authors declare that they have no conflicts of interest. Author LH has received speaker honorarium from Gilead and Astellas. IN has received speaker honorarium from Astellas and Gilead and is on the advisory board of Gilead. BOJ has received research funding from the Norwegian Surveillance Program for Antimicrobial Resistance and has received funds for travel from Wyeth.

Additional information

Funding

This study was financially supported by the Norwegian Surveillance System for Antimicrobial Drug resistance.