Risk factors associated with mortality among patients who had candidemia in a university hospital

Alves, Priscila Guerino Vilela; Melo, Sávia Gonçalves Oliveira; Bessa, Meliza Arantes de Souza; Brito, Murilo de Oliveira; Menezes, Ralciane de Paula; Araújo, Lúcio Borges de; Penatti, Mário Paulo Amante; Pedroso, Reginaldo dos Santos; Röder, Denise Von Dolinger de Brito

doi:10.1590/0037-8682-0206-2019

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Revista da Sociedade Brasileira de Medicina Tropical

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Short Communication • Rev. Soc. Bras. Med. Trop. 53 • 2020 • https://doi.org/10.1590/0037-8682-0206-2019 copy

Risk factors associated with mortality among patients who had candidemia in a university hospital

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

INTRODUCTION:

Bloodstream infection due to Candida spp. is a primary cause of morbidity and mortality in tertiary hospitals.

METHODS:

In this retrospective study, we included patients with a positive blood culture for Candida spp. after 48 h of hospitalization.

RESULTS

A total of 335 patients who had candidemia were included in this study. Risk factors associated with mortality were hospitalization in internal medicine units and surgical clinics, age >60 years, mechanical ventilation, orotracheal intubation, hemodialysis, corticosteroids use, and C. parapsilosis infection.

CONCLUSIONS:

This study highlights the importance of health care related to invasive procedures and actions to improve patient immunity.

Key words:
Candidemia; Risk factors; Mortality

Characteristics	Survived		Death		Univariate		95% Confidence		Multivariate		95% Confidence
	(n=152)		(n=183)		analysis		interval		analysis		interval
	N	%	N	%	P-value*	OR	Lower	Upper	P-value*	OR	Lower	Upper
Age
0 - 30 days^a	15	9.9	9	4.9	-	-	-	-	-	-	-	-
31 days- 1 years old	15	9.9	12	6.6	0.61	1.33	0.43	4.10	-	-	-	-
>2 -11 years old	16	10.5	4	2.2	0.21	0.41	0.11	1.64	-	-	-	-
>12-24 years old	12	7.9	0	0	0.99	1.00	-	-	-	-	-	-
>25-39 years old	18	11.8	17	9.3	0.40	1.57	0.55	4.54	-	-	-	-
40-59 years old	49	32.2	52	28.4	0.22	1.76	0.71	4.41	-	-	-	-
>60 years old	27	17.8	89	48.6	<0.01*	5.49	2.16	13.95	-	-	-	-
Males	92	50.3	91	59.9	0.07	0.68	0.44	1.04	-	-	-	-
Surgery of the gastrointestinal tract	32	21.6	56	30.8	0.06	1.61	0.97	2.66	-	-	-	-
Comorbidity
Renal transplantation	3	2.0	1	0.5	0.26	0.27	0.02	2.65	-	-	-	-
HIV	4	2.8	6	3.3	0.76	1.21	0.33	4.39	-	-	-	-
Neoplasia	26	17.9	44	24.4	0.15	1.48	0.85	2.55	-	-	-	-
Cardiopathy	9	6.2	19	10.6	0.16	1.78	0.78	4.07	-	-	-	-
Diabetes mellitus	16	11.0	24	13.3	0.53	1.24	0.63	2.43	-	-	-	-
Hypertension	30	20.7	48	26.7	0.21	1.39	0.82	2.34	-	-	-	-
Invasive procedures
Mechanical ventilation	70	47.6	121	66.5	<0.01*	2.18	1.39	3.41	<0.01*	2.18	1.24	3.72
Tracheostomy	31	21.2	38	20.9	0.93	0.97	0.57	1.66	-	-	-	-
CVC	137	93.2	163	89.6	0.25	0.62	0.28	1.39	-	-	-	-
Nasoenteral catheter	85	57.8	108	59.3	0.78	1.06	0.68	1.65	-	-	-	-
Hemodialysis	18	12.3	85	46.7	<0.01*	6.23	3.51	11.05	<0.01*	5.10	2.68	9.73
Parenteral nutrition	71	48.3	63	34.6	0.01*	0.56	0.36	0.88	-	-
Colostomy bag	7	4.8	14	7.7	0.28	1.66	0.65	4.24	-	-
Orotracheal intubation	7	4.8	32	17.6	<0.01*	4.26	1.82	9.97	<0.01*	4.93	1.74	14.00
Antifungal agents
Fluconazole	134	89.3	152	83.1	0.10	0.58	0.30	1.11	-	-	-	-
Time of use (days)^b	11.6±11.2		15.9±17.5		0.01*	0.97	0.95	0.99	0.04*	0.97	0.95	0.99
Amphotericin B	31	20.7	18	9.8	<0.01*	0.41	0.22	0.78	-	-	-	-
Time of use (days)^b	1.2±5.1		3.3±8.0		<0.01*	0.95	0.91	0.98	-	-	-	-
Micafungin	23	15.3	30	16.4	0.79	1.08	0.59	1.95	-	-	-	-
Time of use (days)^b	2.1±6.2		2.2±6.0		0.84	0.99	0.96	1.03	-	-	-	-
Use of corticosteroids	70	50.7	126	72.0	0.00*	2.49	1.56	3.99	0.01*	2.23	1.26	3.90
Species
C. albicans	70	46.1	84	45.9	0.97	0.99	0.64	1.53	-	-	-	-
C. tropicalis	34	22.4	41	22.7	0.99	1.00	0.59	1.68	-	-	-	-
C. parapsilosis sensu lato	19	12.5	39	21.3	0.03*	1.90	1.04	3.44	0.01*	2.51	1.17	5.40
C. krusei	7	4.6	7	3.8	0.73	0.83	0.28	2.41	-	-	-	-
C. glabrata complex	14	9.2	16	8.7	0.88	0.94	0.44	2.00	-	-	-	-
Others**	11	7.2	13	7.1	0.96	0.98	0.42	2.25	-	-	-	-

Characteristics	Survived		Death		Univariate		95% Confidence		Multivariate		95% Confidence
	(n=152)		(n=183)		analysis		interval		analysis		interval
	n	%	N	%	P-value*	OR	Lower	Upper	P-value*	OR	Lower	Upper
ICU hospitalization	99	65.1	119	65.0	0.98	0.99	0.63	1.56	-	-	-	-
NICU	17	11.2	16	8.7	0.45	0.76	0.37	1.56	-	-	-	-
PICU	17	11.2	7	3.8	0.01*	0.31	0.12	0.78	-	-	-	-
AICU	65	42.8	92	50.3	0.17	1.35	0.87	2.08	-	-	-	-
CIUC	1	0.7	2	1.1	0.67	1.66	0.14	18.58	-	-	-	-
ICU hospitalization time (days)^a	19.9±30.0		20.0±24.9		0.97	1.00	0.992	1.008	-	-	-	-
Surgical clinic	31	20.4	60	33.0	<0.01*	1.94	1.17	3.20	-	-	-	-
Internal medicine	16	10.5	34	18.6	0.03*	1.97	1.04	3.72	-	-	-	-
Emergency unit	50	32.9	29	16.0	<0.01*	0.39	0.23	0.66	<0.01	0.33	0.19	0.56
Pediatric	18	11.8	4	2.2	<0.01*	0.17	0.06	0.51	<0.01*	0.14	0.05	0.42
Oncology	7	4.6	9	5.0	0.87	1.08	0.39	2.98	-	-	-	-
Others	13	8.6	17	9.3	0.78	1.11	0.52	2.36	-	-	-	-
Hospitalization time before positive culture (days)^a	32.9±44.3		36.6±51.8		0.45	0.999	0.99	1.003	-	-	-	-
Total hospitalization time (days)^a	56.0±76.6		74.9±51.4		0.01*	0.999	0.99	0.999	0.04*	0.996	0.992	0.999

Sociedade Brasileira de Medicina Tropical - SBMT Sociedade Brasileira de Medicina Tropical - SBMT, Núcleo de Medicina Tropical UnB, Sala 43C 70904-970, E-mails: rsbmt@uftm.edu.br | artes.rsbmt@gmail.com | sbmt@sbmt.org.br , WhatsApp: SBMT (61) 9.9192-6496, WhatsApp: RSBMT (34) 9.9996-5807 - Brasília - DF - Brazil
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[1] Corresponding author: Reginaldo dos Santos Pedroso. e-mail:rpedroso@ufu.br