Epidemiological Trends of Candidemia and the Impact of Adherence to the Candidemia Guideline: Six-Year Single-Center Experience
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Definition
2.3. Statistical Analysis
3. Results
3.1. Patient Population and Clinical Characteristics Stratified by Study Periods
3.2. Analysis of Risk Factors for Mortality
3.3. Candidemia and Candida Species with Resistance Patterns
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total | Period 1 | Period 2 | p-Value | |
---|---|---|---|---|
N = 223 (%) | (2013–2015) | (2016–2018) | ||
N = 69, (%) | N = 154, (%) | |||
Age, median (IQR 1) | 71 (60–79) | 67 (57–76) | 72 (64–80) | 0.027 |
Age ≥ 75 years | 85 (38.1) | 18 (26.1) | 67 (43.5) | 0.013 |
Male | 127 (57.0) | 46 (66.7) | 81 (52.6) | 0.05 |
Female | 96 (43.0) | 23 (33.3) | 73 (47.4) | |
Main comorbidities | ||||
Charlson comorbidity index, median (IQR) | 3 (1–6) | 3 (2–6) | 3 (1–6) | 0.97 |
Diabetes mellitus | 83 (37.2) | 24 (34.8) | 59 (38.3) | 0.614 |
Malignancy | 113 (50.7) | 39 (56.5) | 74 (48.1) | 0.242 |
Chronic central nervous system disease | 64 (28.7) | 16 (23.2) | 48 (31.2) | 0.223 |
Chronic kidney disease | 72 (32.3) | 19 (27.5) | 53 (34.4) | 0.31 |
Chronic liver disease | 28 (12.6) | 11 (15.9) | 17 (11.0) | 0.307 |
Chronic pulmonary disease | 30 (13.5) | 9 (13.0) | 21 (13.6) | 0.905 |
Chronic heart disease | 103 (46.2) | 36 (52.2) | 67 (43.5) | 0.23 |
Clinical conditions | ||||
Mechanical ventilation | 66 (29.6) | 13 (18.8) | 53 (34.4) | 0.019 |
Urinary catheter | 166 (74.4) | 41 (59.4) | 125 (81.2) | 0.001 |
Central venous catheter | 160 (71.7) | 47 (68.1) | 113 (73.4) | 0.42 |
Parenteral nutrition | 207 (92.8) | 60 (87.0) | 147 (95.5) | 0.045 |
Hemodialysis | 46 (20.6) | 11 (15.9) | 35 (22.7) | 0.247 |
Steroid use | 98 (43.9) | 40 (58.0) | 58 (37.7) | 0.005 |
Neutropenia | 19 (8.5) | 10 (14.5) | 9 (5.8) | 0.032 |
Chemotherapy | 60 (26.9) | 18 (26.1) | 42 (27.3) | 0.854 |
Duration of hospital stay before candidemia diagnosis median days, (IQR) | 20 (8–41) | 13 (6–33) | 21 (9–45) | 0.046 |
Recent surgery in the current admission | 61 (27.4) | 32 (46.4) | 29 (18.8) | <0.001 |
Previous admission to intensive care unit within 3 months | 84 (37.7) | 21 (30.4) | 63 (40.9) | 0.136 |
Previous use of antibiotics within 1 month | 200 (89.7) | 64 (92.8) | 136 (88.3) | 0.313 |
Source of candidemia | ||||
Gastrointestinal tract | 26 (11.7) | 6 (8.7) | 20 (13.0) | 0.356 |
Central venous catheter | 130 (58.3) | 35 (50.7) | 95 (61.7) | 0.125 |
Urinary tract | 12 (5.4) | 0 (0.0) | 12 (7.8) | 0.02 |
Abscess | 3 (1.3) | 0 (0.0) | 3 (1.9) | 0.554 |
Others or unknown | 52 (23.3) | 28 (40.6) | 24 (15.6) | <0.001 |
Antifungal treatment | ||||
No antifungal treatment | 41 (18.4) | 17 (24.6) | 24 (15.6) | 0.107 |
Antifungal treatment | 182 (81.6) | 52 (75.4) | 130 (84.4) | |
Fluconazole | 60/182 (33.0) | 29/52 (55.8) | 31/130 (23.8) | <0.001 |
Voriconazole | 1/182 (0.5) | 1/52 (1.9) | 0/130 (0.0) | 0.286 |
Amphotericin B | 5/182 (2.7) | 4/52 (7.7) | 1/130 (0.8) | 0.024 |
Echinocandins 2 | 116/182 (63.7) | 18/52 (34.6) | 98/130 (75.4) | <0.001 |
Antifungal treatment duration, median days (IQR) | 13 (5–16) | 11 (6–16) | 13 (5–16) | 0.885 |
Length of hospital stay after diagnosis of candidemia, median days (IQR) | 19 (7–34) | 13 (6–33) | 19 (7–35) | 0.734 |
EQUAL Candida score 3 | ||||
For overall patients, median (IQR) | 15 (14–17) | 14 (12–17) | 16 (14–18) | <0.001 |
For patients with central venous catheter 4 (IQR) | 17 (14–18) | 15 (14–17) | 17 (14–18) | 0.001 |
For patients without central venous catheter 5 (IQR) | 14 (12–15) | 12 (11–14) | 14 (12–15) | 0.04 |
Mortality day 30 after diagnosis of candidemia | 104 (46.6) | 30 (43.5) | 74 (48.1) | 0.527 |
Total N = 223 (%) | Survivor N = 119, (%) | Non-Survivor N = 104, (%) | p-Value | |
---|---|---|---|---|
Age, median (IQR 1) | 71 (60–79) | 71 (60–79) | 72 (59–79) | 0.725 |
Age ≥ 75 years | 85 (38.1) | 46 (38.7) | 39 (37.5) | 0.859 |
Male Female | 127 (57.0) 96 (43.0) | 68 (57.1) 51 (42.9) | 59 (56.7) 45 (43.3) | 0.951 |
Main comorbidities | ||||
Charlson comorbidity index, median (IQR) | 3 (1–6) | 3 (1–5) | 3 (1–6) | 0.078 |
Charlson comorbidity index ≥ 4 | 91 (40.8) | 42 (35.3) | 49 (47.1) | 0.073 |
Diabetes mellitus | 83 (37.2) | 45 (37.8) | 38 (36.5) | 0.844 |
Malignancy | 113 (50.7) | 55 (46.2) | 58 (55.8) | 0.155 |
Chronic central nervous system disease | 64 (28.7) | 36 (30.3) | 28 (26.9) | 0.584 |
Chronic kidney disease | 72 (32.3) | 34 (28.6) | 38 (36.5) | 0.204 |
Chronic liver disease | 28 (12.6) | 12 (10.1) | 16 (15.4) | 0.233 |
Chronic pulmonary disease | 30 (13.5) | 15 (12.6) | 15 (14.4) | 0.691 |
Chronic heart disease | 103 (46.2) | 59 (49.6) | 44 (42.3) | 0.277 |
Clinical conditions | ||||
Mechanical ventilation | 66 (29.6) | 24 (20.2) | 42 (40.4) | 0.001 |
Urinary catheter | 166 (74.4) | 83 (69.7) | 83 (79.8) | 0.086 |
Central venous catheter | 160 (71.7) | 78 (65.5) | 82 (78.8) | 0.028 |
Parenteral nutrition | 207 (92.8) | 108 (90.8) | 99 (95.2) | 0.200 |
Hemodialysis | 46 (20.6) | 15 (12.6) | 31 (29.8) | 0.002 |
Steroid use | 98 (43.9) | 43 (36.1) | 55 (52.9) | 0.012 |
Neutropenia | 19 (8.5) | 3 (2.5) | 16 (15.4) | 0.001 |
Chemotherapy | 60 (26.9) | 26 (21.8) | 34 (32.7) | 0.069 |
Duration of hospital stay before candidemia diagnosis median days, (IQR) | 20 (8–41) | 12 (5–28) | 29 (15–49) | <0.001 |
Duration of hospital stay before candidemia diagnosis ≥ 21 days | 111 (49.8) | 44 (37.0) | 67 (64.4) | <0.001 |
Recent surgery in the current admission | 61 (27.4) | 36 (30.3) | 25 (24.0) | 0.299 |
Previous admission to intensive care unit within 3 months | 84 (37.7) | 36 (30.3) | 48 (46.2) | 0.014 |
Previous use of antibiotics within 1 month | 200 (89.7) | 106 (89.1) | 94 (90.4) | 0.748 |
Source of candidemia | ||||
Gastrointestinal tract | 26 (11.7) | 15 (12.6) | 11 (10.6) | 0.638 |
Central venous catheter | 130 (58.3) | 62 (52.1) | 68 (65.4) | 0.045 |
Urinary tract | 12 (5.4) | 7 (5.9) | 5 (4.8) | 0.723 |
Abscess | 3 (1.3) | 2 (1.7) | 1 (1.0) | 1.000 |
Others or unknown | 52 (23.3) | 33 (27.7) | 19 (18.3) | 0.096 |
Candida species of candidemia C. albicans C. parapsilosis C. tropicalis C. glabrata C. krusei C. guilliermondii C. utilis Other Candida species 2 | 93 (41.7) 46 (20.6) 52 (23.3) 21 (9.4) 2 (0.9) 4 (1.8) 2 (0.9) 3 (1.3) | 49 (41.2) 32 (26.9) 20 (16.8) 14 (11.8) 2 (1.7) 0 (0.0) 2 (1.7) 0 (0.0) | 44 (42.3) 14 (13.5) 32 (30.8) 7 (6.7) 0 (0.0) 4 (3.8) 0 (0.0) 3 (2.9) | 0.864 0.013 0.014 0.199 0.500 0.046 0.500 1.000 |
Antifungal treatment No antifungal treatment Antifungal treatment | 41 (18.4) 182 (81.6) | 11 (9.2) 108 (90.8) | 30 (28.8) 74 (71.2) | <0.001 |
Fluconazole Voriconazole Amphotericin B Echinocandins 3 | 60/182 (33.0) 1/182 (0.5) 5/182 (2.7) 116/182 (63.7) | 44/108 (40.7) 1/108 (0.8) 3/108 (2.8) 60/108 (50.4) | 16/74 (21.6) 0/74 (0.0) 2/74 (2.7) 56/74 (75.7) | 0.007 1.000 1.000 0.006 |
Septic shock Mycological failure | 86 (38.6) 85 (38.5) | 23 (19.3) 10 (8.5) | 63 (60.6) 75 (72.1) | <0.001 <0.001 |
EQUAL Candida score 4 For overall patients, median (IQR) EQUAL score < 15 for overall patients | 15 (14–17) 99 (44.4) | 15 (14–18) 44 (37.0) | 14 (14–17) 55 (52.9) | 0.222 0.017 |
For patients with central venous catheter 5 (IQR) | 17 (14–18) | 17 (14–18) | 16 (14–17) | 0.052 |
EQUAL score < 15 for patients with central venous catheter 5 | 58 (36.0) | 21 (26.9) | 37 (44.6) | 0.020 |
For patients without central venous catheter 6 (IQR) | 14 (12–15) | 14 (12–15) | 14 (11–14) | 0.074 |
EQUAL score < 12 for patients without central venous catheter 6 | 14 (22.6) | 6 (14.6) | 8 (38.1) | 0.054 |
Odds Ratio | 95% Confidence Interval | p-Value | |
---|---|---|---|
Charlson comorbidity index ≥ 4 | 3.302 | 1.276–8.546 | 0.014 |
Neutropenia | 7.855 | 1.669–36.963 | 0.009 |
Duration of hospital stay before candidemia diagnosis ≥ 21 days | 2.475 | 1.067–5.746 | 0.035 |
Septic shock | 4.242 | 1.710–10.524 | 0.002 |
Mycological failure | 29.519 | 11.175–77.970 | <0.001 |
EQUAL Candida score 1 < 15 | 3.501 | 1.380–8.881 | 0.008 |
Mechanical ventilation | 3.028 | 0.999–9.177 | 0.050 |
Total N = 223 (%) | Period 1 (2013–2015) N = 69, (%) | Period 2 (2016–2018) N = 154, (%) | p-Value | |
---|---|---|---|---|
C. albicans Fluconazole susceptibility | 93 (41.7) 87/93 (93.5) | 27 (39.1) 27/27 (100.0) | 66 (42.9) 6/60 (90.9) | 0.602 0.176 |
C. parapsilosis Fluconazole susceptibility | 46 (20.6) 34/46 (73.9) | 12 (17.4) 12/12 (100.0) | 34 (22.1) 22/34 (64.7) | 0.424 0.020 |
C. tropicalis Fluconazole susceptibility | 52 (23.3) 51/52 (98.1) | 15 (21.7) 15/15 (100.0) | 37 (24.0) 36/37 (97.3) | 0.709 1.000 |
C. glabrata Fluconazole susceptibility 1 | 21 (9.4) 19/20 (95.0) | 12 (17.4) 11/11 (100.0) | 9 (5.8) 8/9 (88.9) | 0.006 0.450 |
C. krusei Fluconazole susceptibility | 2 (0.9) 0/2 (0.0) | 0 (0.0) NA 2 | 2 (1.3) 0/2 (0.0) | 1.000 NA |
C. guilliermondii Fluconazole susceptibility | 4 (1.8) 4/4 (100.0) | 1 (1.4) 1/1 (100.0) | 3 (1.9) 3/3 (100.0) | 1.000 NA |
C. utilis Fluconazole susceptibility | 2 (0.9) 2/2 (100.0) | 0 (0.0) NA | 2 (1.3) 2/2 (100.0) | 1.000 NA |
Other Candida species 3 Fluconazole susceptibility 4 | 3 (1.3) 2/2 (100.0) | 2 (2.9) 1/1 (100.0) | 1 (0.6) 1/1 (100.0) | 0.227 NA |
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Kim, J.H.; Suh, J.W.; Kim, M.J. Epidemiological Trends of Candidemia and the Impact of Adherence to the Candidemia Guideline: Six-Year Single-Center Experience. J. Fungi 2021, 7, 275. https://doi.org/10.3390/jof7040275
Kim JH, Suh JW, Kim MJ. Epidemiological Trends of Candidemia and the Impact of Adherence to the Candidemia Guideline: Six-Year Single-Center Experience. Journal of Fungi. 2021; 7(4):275. https://doi.org/10.3390/jof7040275
Chicago/Turabian StyleKim, Jong Hun, Jin Woong Suh, and Min Ja Kim. 2021. "Epidemiological Trends of Candidemia and the Impact of Adherence to the Candidemia Guideline: Six-Year Single-Center Experience" Journal of Fungi 7, no. 4: 275. https://doi.org/10.3390/jof7040275