Candidaemia in a tertiary hospital: analysis of trends and mortality

Abstract number: P1787

Martin-Davila P., Fortun J., Belso A., Luengo J., Agundez M., Alvarez M., Sanchez-Sousa A., Loza E., Moreno S.

Background: Candidaemia is associated with significant mortality and morbidity.

Methods: Retrospective review of the episodes of candidaemia diagnosed from Jan.00 to Dec.05 in our Centre. We include all episodes with, at least, 1 positive BC yielding Candida sp. Clinical, microbiological and epidemiological data were obtained and analysed. Candidaemia was considered nosocomially-acquired (N-A) if the diagnosis was done 72 h after hospital admission (HA) also pts diagnosed after discharge within 60 d of a previous admission.

Results: 146 episodes of candidaemia were identified. Mean age was 54 yrs-o (2 m-96 yrs-o). Mean time from HA to candidaemia was 27 d (0–150, ±25). 89% were considered N-A. Origin of candidaemia was catheter-related (CR) in 40%, followed by primary candidaemia(PC) (30%), urinary tract infection (UTI) (10%) and intrabdominal infection (IAI) (9%). 51% were C. albicans (CA) and 48% were caused by non-albicans species (NA-C). 39% were oncohaematologic (OH) patients. In OH-pts is more frequent N-A spp. (55%). 11% have neutropenia. Attending to the site of admission:medical wards (42%), ICU (39%), surgical wards (19%). In CR infection the most frequent isolated was C. parapsilosis (57.6%). C. albicans was the predominant species in PC (53.5%), UTI (64%) and IAI (61%). N of episodes of candidaemia per year has increased (15 cases/yr in 2000 to 32 cases/yr in 2005). The distribution of CA and NA-C spp. per year remains stable. Mortality during 1st month was 39%. Mean time from candidaemia to exitus was 11 d (0–30, ±9.1). Mortality rates varies according to the different origin of candidaemia: CR (32%), PC (44%), UTI (28.6%), IAI (23%).

In univariate analysis of mortality, N-A (p = 0.001), age 50 yrs-old (p = 0.02), presence of metastatic neoplasia (p = 0.004), shock (p < 0.001), renal failure (p = 0.005), respiratory failure (p = 0.01) and receiving antifungal therapy <5 d (p < 0.001) were associated with mortality.

Conclusions: The number of cases of candidaemia per year is increasing. The distribution of CA and NA-C spp. remains stable. The most frequent source of candidaemia was catheter-related. Candidaemia has a high mortality rate. Age, presence of metastatic neoplasia, shock, renal failure, respiratory failure and receiving antifungal therapy <5 d was associated with mortality in univariate analysis.