Infect Chemother.  2011 Aug;43(4):349-354. 10.3947/ic.2011.43.4.349.

Risk Factors and Prognosis for Persistent Candidemia without Catheter Colonization

• Chae YT
• Jeong SJ
• Ku NS
• Baek JH
• Kim H
• Kim SB
• Yoon JH
• Jin SJ
• Han SH
• Song YG
• Kim JM
• Choi JY

• KMID: 1936072
• DOI: http://doi.org/10.3947/ic.2011.43.4.349

Abstract

BACKGROUND
Candidemia is one of the most common causes of nosocomial bloodstream infection, and increases the morbidity and mortality rate of seriously ill patients. We evaluated the risk factors and outcomes associated with persistent candidemia without catheter colonization (non-catheter related candidemia) and compared them with those of non-persistent candidemia.
MATERIALS AND METHODS
A retrospective case-control study was performed to identify risk factors for, and outcomes of, persistent candidemia. All adults who experienced candidemia in a university-affiliated hospital in Korea between January 2005 and December 2009 were included. Patients with catheter colonization were excluded. Persistent candidemia was defined as the occurrence of candidemia in a patient receiving at least 3 days of systemic antifungal agents prior to the second positive blood culture.
RESULTS
Of 605 adult patients with candidemia, 104 (17.2%) patients had persistent candidemia and 23 (3.8%) patients were free of catheter colonization. There were no statistically significant differences in baseline characteristics between patients with persistent and non-persistent candidemia. In univariate analysis, less use of metronidazole, glycopeptide, fluoroquinolone, and aminoglycoside, and presence of Candida parapsilosis were significantly associated with persistent candidemia. In multivariate analysis, less use of metronidazole was an independent factor associated with persistent candidemia. The candidemia related mortality was insignificantly (P=0.094) higher in persistent candidemia than non-persistent candidemia.
CONCLUSIONS
Persistent candidemia can occur without catheterization. Patterns of antibiotic use could be associated with the occurrence of persistent candidemia, and prognosis of persistent candidemia seems to be worse than non-persistent candidemia. Further studies for persistent candidemia should be performed.

Keyword

Candidemia; Risk factors; Mortality

MeSH Terms

Adult
Antifungal Agents
Candida
Candidemia
Case-Control Studies
Catheterization
Catheters
Colon
Humans
Korea
Metronidazole
Multivariate Analysis
Prognosis
Retrospective Studies
Risk Factors
Antifungal Agents
Metronidazole

Figure

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  Figure 1 Kaplan-Meier survival curves for candidemia.

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