Methods:Patients with Candid spp. growth in blood cultures at our hospital between 2009-2014 were investigated retrospectively. Patients’ demographic and clinical characteristics, laboratory results, time to start of appropriate treatment, Charlson comorbidity index (CCI), SOFA and Pitt scores and prognoses were recorded from medical files. The data obtained were analyzed on SPSS 13.0.
Results:115 patients were enrolled. Mean CCI score was 4.2±2.2, mean SOFA score was 7.4±4.1 and mean Pitt score was 4.8±3.2. Agents were C.albicans in 41.7%, C.guillermondi in 20%, C.parapsilosis in 17.4% and other non-Candida spp. in 20.9%. The crude mortality rate in the patients enrolled in the study was 65.2%. CCI, SOFA and Pitt scores were significantly high in the non-surviving patients (Table 1). Ten of the non-surviving patients were not started on antifungal therapy, 32 patients were started on appropriate antifungal therapy after 3 days and 8 of the surviving patients were started on appropriate antifungal therapy after 3 days (p=0.026). Multivariate analysis of the risk factors affecting mortality showed that a 1-unit increase in a patient’s CCI, SOFA and Pitt scores increased mortality 1.6, 1.3 and 2.0 fold, respectively, and that failure to start appropriate antifungal therapy in the first 3 days increased mortality 4.6-fold (Table 2). A CCI score above 4, a SOFA score above 7 and a Pitt score above 3 predict mortality in patients with Candidemia with high specificity and sensitivity (Table 3).
Conclusion: Growth generally occurs after 3 days, leading to delays in treatment and increased mortality rates. Greater care is therefore required in the evaluation of at-risk patients in particular. At such evaluation, the use of CCI, SOFA and Pitt scoring systems in patients with risk factors and prompt initiation of antifungal therapy in patients with scores above cut-off values can be life-saving.
I. Koksal, None
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