A comparative study of risk factors and outcome among outpatient-acquired and nosocomial-acquired candidemia

Abstract number: 1134_04_26

Pasqualotto A.C., Nedel W.L., Machado T.S., Severo L.C.

Objectives:  

To describe all cases of candidemia that occurred in the outpatient setting and to compare risk factors and outcome among patients with outpatient-acquired and nosocomial-acquired candidemia.

Methods:  

Retrospective cohort study conducted in Santa Casa Complexo Hospitalar, Brazil, during 1995 and 2003.

Results:  

During the period of study, 210 patients developed candidemia at our Institution, and 9.0% were outpatient-acquired. Most of these outpatients were male, median age was 51 years old, and major underlying diseases were cancer (47.4%) and chronic renal failure (36.8%). Most of the candidemias in the outpatient group occurred within 24 h of hospitalization (63.2%) and 83.7% were caused by species other than Candida albicans, mainly Candida parapsilosis (36.8%). Candida was isolated from catheters in 21%, and most of them (52.6%) had been admitted to the hospital in the 60 days preceding candidemia. Compared to patients with nosocomial-acquired candidemia, chronic renal failure was more frequent in the outpatient group, who were also more commonly exposed to hemodialysis. Ileus, gastrointestinal bleeding, previous bacteraemia, use of proton pump inhibitors, previous stay in the ICU and requirement for antibiotics, blood transfusion, vasopressors and invasive medical procedures were more frequent in the nosocomial group. Overall mortality rate was higher than 50% in both groups.

Conclusion:  

Candidemia must be remembered as a potential etiology for sepsis in the community, and it is associated with a high mortality.