Methods: Patients admitted to two referral hospitals, from July 2008 to June 2014 with a positive blood culture for Candida spp. were included and followed prospectively. The incidence rate of CBSI was calculated. Descriptive and comparative analysis by NAC and 30-day mortality was done. Multivariate analysis was performed: logistic regression for NAC associated factors, and a proportional hazard model for mortality. A p value < 0.05 was considered statistically significant. For the mortality analysis, only episodes with >48hrs of treatment and sufficient data to assess proper treatment (defined as adequate antifungal for the isolated species and appropriate doses) were included.
Results: There were 227 episodes of CBSI among 225 patients. CBSI represented 1.7% of all BSI, the incidence rate was 3 episodes/1000 admissions (3.1/1000 admissions during the first year and 4/1000 admissions during the last year, p=0.5). One hundred and thirty four isolates (59%) were identified as NAC: 37% C. tropicalis, 33% C. glabrata, 15% C. parapsilosis, 4.4% C. guilliermondi. NAC-BSI had a trend to increase from 1.73 to 2.4/1000 admissions (p=0.0.4). Chronic kidney disease (CKD) (OR 5.9 95% CI 1.9-18), previous antifungal therapy (OR 2.7 95% CI 1.3-5.9), and chemotherapy (CT) (OR 2.0 95% CI 1.09-4.0) were independently associated with NAC-BSI. After adjustment with proper treatment and age, early (<72 hr) central venous catheter removal (HR 0.68 95% CI 0.49-0.96), disease severity (APACHE II) (HR 1.06 95% CI 1.03-1.10) and cirrhosis (HR 3.4 95% CI 2.21-5.27) were independently associated to 30-day mortality in NAC-BSI.
Conclusion: NAC-BSI showed a trend to increase the isolation rate in this setting, being C. tropicalis the most prevalent species; CKD, previous antifungals, and CT were major risk factors. Cirrhosis and disease severity were associated with increased 30-day mortality, while early catheter removal seemed to reduce the risk.
M. F. González-Lara,
A. Ponce De Leon-Garduño, Pfizer: Board Member and Scientific Advisor , Grant recipient
MSD: Board Member , Grant recipient
Jannsen-Cilag: Scientific Advisor , Speaker honorarium
P. Cornejo-Juarez, Astra-Zeneca: Scientific Advisor , Speaker honorarium
MSD: Investigator , Research grant
Merck: Speaker's Bureau , Speaker honorarium
Stendhal: Speaker's Bureau , Speaker honorarium
D. E. Corzo-Leon, Pfizer: Collaborator , Salary
J. Sifuentes-Osornio, None