Nosocomial candidemia in adults: Risk and prognostic factors

Abstract

Objective of the study. - Determination of the risk and prognostic factors for candidemias that develop in adult patients (in a general hospital patient population, intensive care unit [ICU] patients and patients with solid organ malignancy).

Patients. - The risk factors for candidemia were investigated in 256 adult patients (>= 18 years old).

Patients and methods. - The risk and prognostic factors for candidemia were investigated in adult patients using a matched case-control design.

Results. - We found that a total of 457 adult patients developed nosocomial candidemia in our hospital over the 12-year study period. Candida albicans (46.8%) was the most common etiological agent in candidemia, whereas C. parapsilosis (27%) was isolated as the second most frequent species. The ratio of C. glabrata was 3.8%. The risk factors for candidemia were investigated in 256 patients for whom full medical record information was available. Total parenteral nutrition (TPN) (OR 1.718; 95% CI 1.139-2.594, P = 0.01), antacid use (OR 1.841; 95% CI 1.239-2.735, P = 0.003) and candiduria (OR 2.095; 95% CI 1.213-3.617, P = 0.008) were detected as independent risk factors for candidemia among all affected patients. Removal of the central venous catheter (OR 1.976; 95% CI 1.219-3.202, P = 0.006) was protective against mortality.

Conclusion. - Candiduria, and use of TPN were the most frequently encountered independent risk factors in almost all patient groups in our study as well as in other studies on this topic, so they should be taken into account in the evaluation of patients with suspicion of candidemia.