Epidemiology, risk factors, and clinical outcome of candidaemia in a tertiary care hospital in Korea
Abstract number: P1795
Lee M.S., Moon S.Y., Moon S.M., Sohn J.S., Lee H.J.
Objectives:Candida spp. is the fourth most common cause of bloodstream infections, and C. albicans is the most common species. However, changes in Candida spp. epidemiology have been reported. The purpose of this study is to determine the epidemiology, risk factors and outcome of C. albicans (CAB) and non-albicans BSI (CNAB) in a tertiary care centre in Korea.
Methods: All inpatient, adult candidaemia cases between 2003 and 2006 were identified at our centre. Demographic characteristics, risk factors, time to antifungal agent, and mortality within 30 days of culture were obtained from retrospective record review.
Results: A total of 300 episodes of candidaemia occurred in 101 patients over the 4-year period. The distributions of species were as follows: 48 C. albicans, 23 C. tropicalis, 13 C. glabrata, 12 C. parapsilosis, 4 unclassified spp., and 1 C. krusei. There was significant difference between the incidences of CAB (32.4%) and CNAB (67.6%) in 2006 (p = 0.021). There was no significant difference in demographic characteristics, risk factors, underlying diseases, time to antifungal therapy, and clinical outcome between CAB and CNAB. Of 73 (72.3%) central venous catheters at the culture date, 43 (53.9%) were removed. Catheter related candidaemia which proven by tip culture was 13 cases. The 57 (56.4%) of these 101 cases were cultured at ICU. Of 101 patients, the median age was 66 year (range, 3286 year); 65.3% were males. Median length of stay before the first positive culture date was 22 days, and APACHE II score at culture date was 18. Antifungal therapy had been done for 59 patients (58.4%) after median 4 days of culture. Fluconazole was primarily used in 45 (76.3%) patients, and switched to amphotericin B (9) as second-line drug. Reasons for absence of antifungal therapy were: death or hopelessly discharged before culture result (24), clinical improvement or felt to contamination (13), and unknown (5). Overall, 52 patients (51.5%) died. Attributable mortality of candidaemia was significantly higher in untreated cases than treated (59.5% vs. 22.0%, p = 0.002).
Conclusion: Currently CNAB is increasing without specific risk factors in our centre. Strategies should be needed to decrease the incidence of untreated candidaemia, which related with high mortality. Educational efforts should be also needed to reinforce the clinical significance of candidaemia, early empiric therapy for high-risk patients, and earlier detection of candidaemia.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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