Risk Factors for Mortality in Colombian Patients with Candidemia
Abstract
:1. Introduction
2. Materials and Methods
2.1. Setting
2.2. Definitions
2.3. Microbiological Procedures
2.4. Ethical Approval
2.5. Statistical Analysis
3. Results
3.1. Microbiological Findings
3.2. Treatment and Outcome
3.3. Risk Factors for Mortality
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Wisplinghoff, H.; Bischoff, T.; Tallent, S.M.; Seifert, H.; Wenzel, R.P.; Edmond, M.B. Nosocomial Bloodstream Infections in US Hospitals: Analysis of 24,179 Cases from a Prospective Nationwide Surveillance Study. Clin. Infect. Dis. 2004, 39, 309–317. [Google Scholar] [CrossRef] [Green Version]
- Rosenthal, V.D.; Chaparro, G.J.; Servolo-Medeiros, E.A.; Souza-Fram, D.; Escudero, D.V.D.S.; Gualtero-Trujillo, S.M.; Morfin-Otero, R.; Gonzalez-Diaz, E.; Rodriguez-Noriega, E.; Altuzar-Figueroa, M.A.; et al. An eight-year multicenter study on short-term peripheral intravenous catheter–related bloodstream infection rates in 100 intensive care units of 9 countries in Latin America: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Venezuela. Findings of the International Nosocomial Infection Control Consortium (INICC). Infect. Control Hosp. Epidemiol. 2021, 1–7. [Google Scholar] [CrossRef]
- Lin, S.; Chen, R.; Zhu, S.; Wang, H.; Wang, L.; Zou, J.; Yan, J.; Zhang, X.; Farmakiotis, D.; Tan, X.; et al. Candidemia in Adults at a Tertiary Hospital in China: Clinical Characteristics, Species Distribution, Resistance, and Outcomes. Mycopathologia 2018, 183, 679–689. [Google Scholar] [CrossRef]
- Lagunes, L.; Rey-Pérez, A.; Martín-Gómez, M.T.; Vena, A.; de Egea, V.; Muñoz, P.; Bouza, E.; Díaz-Martín, A.; Palacios-García, I.; Garnacho-Montero, J.; et al. Association between source control and mortality in 258 patients with intra-abdominal candidiasis: A retrospective multi-centric analysis comparing intensive care versus surgical wards in Spain. Eur. J. Clin. Microbiol. Infect. Dis. 2016, 36, 95–104. [Google Scholar] [CrossRef]
- Nucci, M.; Queiroz-Telles, F.; Alvarado-Matute, T.; Tiraboschi, I.N.; Cortes, J.; Zurita, J.; Guzman-Blanco, M.; Santolaya, M.E.; Thompson, L.; Sifuentes-Osornio, J.; et al. Epidemiology of Candidemia in Latin America: A Laboratory-Based Survey. PLoS ONE 2013, 8, e59373. [Google Scholar] [CrossRef] [Green Version]
- Rosenthal, V.D.; Al-Abdely, H.M.; El-Kholy, A.A.; AlKhawaja, S.A.A.; Leblebicioglu, H.; Mehta, Y.; Rai, V.; Hung, N.V.; Kanj, S.S.; Salama, M.F.; et al. International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010–2015: Device-associated module. Am. J. Infect. Control 2016, 44, 1495–1504. [Google Scholar] [CrossRef]
- da Matta, D.A.; Souza, A.C.R.; Colombo, A.L. Revisiting Species Distribution and Antifungal Susceptibility of Candida Bloodstream Isolates from Latin American Medical Centers. J. Fungi 2017, 3, 24. [Google Scholar] [CrossRef] [Green Version]
- Alvarez-Moreno, C.A.; Cortes, J.A.; Denning, D.W. Burden of Fungal Infections in Colombia. J. Fungi 2018, 4, 41. [Google Scholar] [CrossRef] [Green Version]
- CLSI. M27 Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts; CLSI M27: Wayne, PA, USA, 2017. [Google Scholar]
- Nguyen, M.H.; Clancy, C.J.; Yu, V.L.; Yu, Y.C.; Morris, A.J.; Snydman, D.R.; Sutton, D.A.; Rinaldi, M.G. Do In Vitro Susceptibility Data Predict the Microbiologic Response to Amphotericin B? Results of a Prospective Study of Patients with Candida Fungemia. J. Infect. Dis. 1998, 177, 425–430. [Google Scholar] [CrossRef] [Green Version]
- Garnacho-Montero, J.; Díaz-Martín, A.; García-Cabrera, E.; de Pipaón, M.R.P.; Hernández-Caballero, C.; Lepe-Jiménez, J.A. Impact on hospital mortality of catheter removal and adequate antifungal therapy in Candida spp. bloodstream infections. J. Antimicrob. Chemother. 2012, 68, 206–213. [Google Scholar] [CrossRef] [Green Version]
- Cortés, J.A.; Reyes, P.; Gómez, C.H.; Cuervo, S.I.; Rivas, P.; Casas, C.A.; Sanchez, R. Clinical and epidemiological characteristics and risk factors for mortality in patients with candidemia in hospitals from Bogotá, Colombia. Braz. J. Infect. Dis. 2014, 18, 631–637. [Google Scholar] [CrossRef] [Green Version]
- Puig-Asensio, M.; Pemán, J.; Zaragoza, R.; Garnacho-Montero, J.; Martín-Mazuelos, E.; Cuenca-Estrella, M.; Almirante, B. Impact of Therapeutic Strategies on the Prognosis of Candidemia in the ICU. Crit. Care Med. 2014, 42, 1423–1432. [Google Scholar] [CrossRef] [Green Version]
- Barchiesi, F.; Orsetti, E.; Mazzanti, S.; Trave, F.; Salvi, A.; Nitti, C.; Manso, E. Candidemia in the elderly: What does it change? PLoS ONE 2017, 12, e0176576. [Google Scholar] [CrossRef] [Green Version]
- Pinhati, H.M.S.; Casulari, L.A.; Souza, A.C.R.; Siqueira, R.A.; Damasceno, C.M.G.; Colombo, A.L. Outbreak of candidemia caused by fluconazole resistant Candida parapsilosis strains in an intensive care unit. BMC Infect. Dis. 2016, 16, 433. [Google Scholar] [CrossRef]
- Korol, E.; Johnston, K.; Waser, N.; Sifakis, F.; Jafri, H.S.; Lo, M.; Kyaw, M.H. A Systematic Review of Risk Factors Associated with Surgical Site Infections among Surgical Patients. PLoS ONE 2013, 8, e83743. [Google Scholar] [CrossRef] [Green Version]
- Muskett, H.; Shahin, J.; Eyres, G.; Harvey, S.; Rowan, K.; Harrison, D. Risk factors for invasive fungal disease in critically ill adult patients: A systematic review. Crit. Care 2011, 15, R287. [Google Scholar] [CrossRef] [Green Version]
- Wu, Z.; Liu, Y.; Feng, X.; Liu, Y.; Wang, S.; Zhu, X.; Chen, Q.; Pan, S. Candidemia: Incidence rates, type of species, and risk factors at a tertiary care academic hospital in China. Int. J. Infect. Dis. 2014, 22, 4–8. [Google Scholar] [CrossRef] [Green Version]
- Bader, M.S.; Lai, S.M.; Kumar, V.; Hinthorn, D. Candidemia in patients with diabetes mellitus: Epidemiology and predictors of mortality. Scand. J. Infect. Dis. 2004, 36, 860–864. [Google Scholar] [CrossRef]
- Jia, X.; Li, C.; Cao, J.; Wu, X.; Zhang, L. Clinical characteristics and predictors of mortality in patients with candidemia: A six-year retrospective study. Eur. J. Clin. Microbiol. Infect. Dis. 2018, 37, 1717–1724. [Google Scholar] [CrossRef]
- Kaur, H.; Chakrabarti, A. Strategies to Reduce Mortality in Adult and Neonatal Candidemia in Developing Countries. J. Fungi 2017, 3, 41. [Google Scholar] [CrossRef] [Green Version]
- Doi, A.M.; Pignatari, A.C.C.; Edmond, M.B.; Marra, A.R.; Camargo, L.F.A.; Siqueira, R.A.; da Mota, V.P.; Colombo, A.L. Epidemiology and Microbiologic Characterization of Nosocomial Candidemia from a Brazilian National Surveillance Program. PLoS ONE 2016, 11, e0146909. [Google Scholar] [CrossRef]
- Berrio, I.; Maldonado, N.; de Bedout, C.; Arango, K.; Cano, L.E.; Valencia, Y.; Jiménez-Ortigosa, C.; Perlin, D.S.; Gómez, B.L.; Robledo, C.; et al. Comparative study of Candida spp. isolates: Identification and echinocandin susceptibility in isolates obtained from blood cultures in 15 hospitals in Medellín, Colombia. J. Glob. Antimicrob. Resist. 2018, 13, 254–260. [Google Scholar] [CrossRef]
- Morales-Lopez, S.E.; Parra-Giraldo, C.M.; Ceballos-Garzón, A.; Martínez, H.P.; Rodríguez, G.J.; Álvarez-Moreno, C.A.; Rodríguez, J.Y. Invasive Infections with Multidrug-Resistant Yeast Candida auris, Colombia. Emerg. Infect. Dis. 2017, 23, 162–164. [Google Scholar] [CrossRef] [Green Version]
- Lamoth, F.; Lewis, R.E.; Kontoyiannis, D.P. Role and Interpretation of Antifungal Susceptibility Testing for the Management of Invasive Fungal Infections. J. Fungi 2020, 7, 17. [Google Scholar] [CrossRef]
- de Bedout, C.; Ayabaca, J.; Vega, R.; Méndez, M.; Santiago, A.R.; Pabón, M.L.; Tabares, A.; Arango, M.; Restrepo, A.; Newell, V. Evaluation of Candida species’ susceptibility to fluconazole with the disk diffusion method. Biomedica 2003, 23, 31–37. [Google Scholar] [CrossRef] [Green Version]
- Maldonado, N.A.; Cano, L.E.; de Bedout, C.; Arbeláez, C.A.; Roncancio, G.; Tabares, Á.M.; Robledo, C.G.; Robledo, J. Association of clinical and demographic factors in invasive candidiasis caused by fluconazole-resistant Candida species: A study in 15 hospitals, Medellín, Colombia 2010–2011. Diagn. Microbiol. Infect. Dis. 2014, 79, 280–286. [Google Scholar] [CrossRef]
- Ghanem-Zoubi, N.; Zorbavel, D.; Khoury, J.; Geffen, Y.; Qasum, M.; Predescu, S.; Paul, M. The association between treatment appropriateness according to EUCAST and CLSI breakpoints and mortality among patients with candidemia: A retrospective observational study. Eur. J. Clin. Microbiol. Infect. Dis. 2018, 37, 2397–2404. [Google Scholar] [CrossRef]
- Cortes, J.A.; Jaimes, J.A.; Leal, A.L. Incidence and prevalence of candidemia in critically ill patients in Colombia. Rev. Chil. Infectol. 2013, 30, 599–604. [Google Scholar] [CrossRef]
Characteristic or Risk Factor | N (%) |
---|---|
Age group | |
Neonate (<30 days) | 18 (16.5) |
Paediatric (30 days to <18 years) | 13 (11.2) |
Adult (≥18 years to ≤60 years) | 52 (47.7) |
Elderly (>60 years) | 26 (23.9) |
Male | 74 (67.9) |
Central catheter | 88 (80.7) |
Parenteral nutrition | 74 (67.9) |
Total parenteral nutrition | 65 (59.6) |
Mechanical ventilation | 65 (59.6) |
ICU admission | 60 (55.0) |
Surgery | 69 (63.3) |
Abdominal | 34 (31.2) |
Orthopaedic | 10 (9.1) |
Other | 35 (32.1) |
Cancer | 24 (22) |
Solid | 16 (14.7) |
Chronic pulmonary diseases | 18 (16.5) |
Renal failure | 16 (14.7) |
Acute | 11 (10.1) |
Cardiac failure | 13 (11.9) |
Diabetes | 13 (11.9) |
Chronic liver disease | 6 (5.5) |
Immunosuppression | 5 (4.6) |
Previous antibiotic use | 109 (100) |
Previous antifungal use | 33 (30.3) |
Neonate and paediatric | 11 (35.5) |
Adult and elderly | 22 (28.2) |
Total number of patients | 109 (100) |
Species (No. of Isolates) | Antifungal | Range | MIC 50 mcg/mL | MIC 90 mcg/mL | Non-Susceptible (%) |
---|---|---|---|---|---|
C. parapsilosis (n = 42) | Amphotericin | 0.25–1 | 0.5 | 1 | 0 |
Anidulafungin | 0.25–2 | 1 | 2 | 0 | |
Fluconazole | 0.125–2 | 0.25 | 2 | 2.4 | |
Voriconazole | 0.03–0.25 | 0.03 | 0.03 | 0 | |
C. albicans (n = 40) | Amphotericin | 0.25–1 | 1 | 1 | 0 |
Anidulafungin | 0.03–1 | 0.25 | 0.25 | 2.5 | |
Fluconazole | 0.125–4 | 0.25 | 0.25 | 0 | |
Voriconazole | 0.03–0.06 | 0.03 | 0.03 | 0 | |
C. tropicalis (n = 19) | Amphotericin | 0.25–1 | 0.5 | 1 | 0 |
Anidulafungin | 0.03–0.5 | 0.125 | 0.5 | 0 | |
Fluconazole | 0.125–0.5 | 0.25 | 0.5 | 0 | |
Voriconazole | 0.03–0.06 | 0.03 | 0.06 | 0 | |
C. glabrata (n = 5) | Amphotericin | 0.5–1 | 1 | 1 | 0 |
Anidulafungin | 0.03–0.25 | 0.125 | 0.25 | 40 | |
Fluconazole | 2–8 | 4 | 8 | 100 | |
Voriconazole | 0.06–0.5 | 0.125 | 0.5 | N.D. | |
Other species (n = 3) | Amphotericin | 0.25–0.5 | 0.5 | 0.5 | 0 |
Anidulafungin | 0.06–1 | 1 | 1 | 66 * | |
Fluconazole | 0.125–2 | 0.125 | 2 | 0 | |
Voriconazole | 0.03–0.06 | 0.03 | 0.06 | N.D |
Survivors N = 66 | Non-Survivors N = 43 | Difference (95% CI) | |
---|---|---|---|
Age (years) * | 29.8 | 46.0 | 16.2 (5.8–26.6) |
Age > 60 years (%) | 15.2 | 37.2 | 22.0 (5.2–38.9) |
Previous length of stay (days) | 19.7 | 28.4 | 8.8 (0.3–17.2) |
Shock (%) | 15.2 | 34.9 | 19.7 (3.1–36.4) |
Apache (points) ** | 12.1 | 15.3 | 3.2 (−13.2–6.5) |
Cancer (%) | 12.1 | 34.9 | 22.8 (6.5–39.0) |
Abdominal surgery (%) | 24.2 | 41.9 | 17.6 (−0.4–35.6) |
Persistent candidemia (%) | 19.7 | 9.3 | 10.4 (−2.5–23.3) |
Catheter removal (%) | 24.2 | 2.3 | 21.9 (10.6–33.2) |
Early treatment (%) | 30.3 | 16.3 | 14.0 (−1.6–29.7) |
No treatment (%) | 12.2 | 30.2 | 18.0 (2.3–33.9) |
Fluconazole as initial treatment(%) | 60.6 | 41.9 | 18.7 (−0.1–37.6) |
Risk Factor | Hazard Ratio | 95% Confidence Interval |
---|---|---|
No antifungal treatment | 5.52 | 3.56–11.42 |
Cancer | 3.93 | 2.34–8.01 |
Diabetes | 2.57 | 1.03–6.40 |
Age (per 10 years) | 1.13 | 1.02–1.24 |
Catheter removal | 0.06 | 0.00–0.49 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Cortés, J.A.; Montañez, A.M.; Carreño-Gutiérrez, A.M.; Reyes, P.; Gómez, C.H.; Pescador, A.; Ariza, B.; Rosso, F. Risk Factors for Mortality in Colombian Patients with Candidemia. J. Fungi 2021, 7, 442. https://doi.org/10.3390/jof7060442
Cortés JA, Montañez AM, Carreño-Gutiérrez AM, Reyes P, Gómez CH, Pescador A, Ariza B, Rosso F. Risk Factors for Mortality in Colombian Patients with Candidemia. Journal of Fungi. 2021; 7(6):442. https://doi.org/10.3390/jof7060442
Chicago/Turabian StyleCortés, Jorge Alberto, Anita María Montañez, Ana María Carreño-Gutiérrez, Patricia Reyes, Carlos Hernando Gómez, Angela Pescador, Beatriz Ariza, and Fernando Rosso. 2021. "Risk Factors for Mortality in Colombian Patients with Candidemia" Journal of Fungi 7, no. 6: 442. https://doi.org/10.3390/jof7060442