Document Detail


Epidemiology and predictors of mortality in cases of Candida bloodstream infection: results from population-based surveillance, barcelona, Spain, from 2002 to 2003.
MedLine Citation:
PMID:  15815004     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We conducted population-based surveillance for Candida bloodstream infections in Spain to determine its incidence, the extent of antifungal resistance, and risk factors for mortality. A case was defined as the first positive blood culture for any Candida spp. in a resident of Barcelona, from 1 January 2002 to 31 December 2003. We defined early mortality as occurring between days 3 to 7 after candidemia and late mortality as occurring between days 8 to 30. We detected 345 cases of candidemia, for an average annual incidence of 4.3 cases/100,000 population, 0.53 cases/1,000 hospital discharges, and 0.73 cases/10,000 patient-days. Outpatients comprised 11% of the cases, and 89% had a central venous catheter (CVC) at diagnosis. Overall mortality was 44%. Candida albicans was the most frequent species (51% of cases), followed by Candida parapsilosis (23%), Candida tropicalis (10%), Candida glabrata (8%), Candida krusei (4%), and other species (3%). Twenty-four isolates (7%) had decreased susceptibility to fluconazole (MIC > or = 16 microg/ml). On multivariable analysis, early death was independently associated with hematological malignancy (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.1 to 10.4). Treatment with antifungals (OR, 0.05; 95% CI, 0.01 to 0.2) and removal of CVCs (OR, 0.3; 95% CI, 0.1 to 0.9) were protective factors for early death. Receiving adequate treatment, defined as having CVCs removed and administration of an antifungal medication (OR, 0.2; 95% CI, 0.08 to 0.8), was associated with lower odds of late mortality; intubation (OR, 7.5; 95% CI, 2.6 to 21.1) was associated with higher odds. The incidence of candidemia and prevalence of fluconazole resistance are similar to other European countries, indicating that routine antifungal susceptibility testing is not warranted. Antifungal medication and catheter removal are critical in preventing mortality.
Authors:
Benito Almirante; Dolors Rodríguez; Benjamin J Park; Manuel Cuenca-Estrella; Ana M Planes; Manuel Almela; Jose Mensa; Ferran Sanchez; Josefina Ayats; Montserrat Gimenez; Pere Saballs; Scott K Fridkin; Juliette Morgan; Juan L Rodriguez-Tudela; David W Warnock; Albert Pahissa;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of clinical microbiology     Volume:  43     ISSN:  0095-1137     ISO Abbreviation:  J. Clin. Microbiol.     Publication Date:  2005 Apr 
Date Detail:
Created Date:  2005-04-07     Completed Date:  2005-06-14     Revised Date:  2013-06-09    
Medline Journal Info:
Nlm Unique ID:  7505564     Medline TA:  J Clin Microbiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1829-35     Citation Subset:  IM    
Affiliation:
Infectious Diseases Division, Hospital Universitari Vall d'Hebron, Avda. Vall d'Hebron, 119-129, 08035 Barcelona, Spain. balmirante@vhebron.net
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Antifungal Agents / pharmacology
Candida / classification*,  drug effects
Candidiasis / epidemiology,  microbiology,  mortality
Child
Child, Preschool
Drug Resistance, Fungal
Female
Fluconazole / pharmacology
Fungemia / epidemiology*,  microbiology,  mortality*
Humans
Incidence
Infant
Infant, Newborn
Male
Microbial Sensitivity Tests
Middle Aged
Population Surveillance*
Predictive Value of Tests
Spain / epidemiology
Chemical
Reg. No./Substance:
0/Antifungal Agents; 86386-73-4/Fluconazole
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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