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Nosocomial candidemia; risk factors and prognosis revisited; 11 years experience from a Norwegian secondary hospital.

Berdal JE, Haagensen R, Ranheim T, Bjørnholt JV - PLoS ONE (2014)

Bottom Line: Urology related cases were all diagnosed in the general ward.Multiple surgical procedures were done in 60% of abdominal surgery patients.Compared with previous national figures the epidemiology of invasive candidiasis seems not to have changed over the last decade.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, Akershus University Hospital, Nordbyhagen, Norway.

ABSTRACT
The aim of the study was to review the epidemiology and prognosis of candidemia in a secondary hospital, and to examine the intra-hospital distribution of candidemia patients. Study design is a retrospective cohort study. Trough 2002-2012, 110 cases of candidemia were diagnosed, giving an incidence of 2, 6/100,000 citizens/year. Overall prognosis of candidemia was dismal, with a 30 days case fatality rate of 49% and one year case fatality rate of 64%. Candidemia was a terminal event in 55% of 30 days non-survivors, defined as Candida blood cultures reported positive on the day of death or thereafter (39%), or treatment refrained due to hopeless short-term prognosis (16%). In terminal event candidemias, advanced or incurable cancer was present in 29%. Non-survivors at 30 days were 9 years (median) older than survivors. In 30 days survivors, candidemia was not recognised before discharge in 13% of cases. No treatment were given and no deaths or complications were observed in this group. Candidemia patients were grouped into 8 patient categories: Abdominal surgery (35%), urology (13%), other surgery (11%), pneumonia (13%), haematological malignancy (7%), intravenous drug abuse (4%), other medical (15%), and new-borns (3%). Candidemia was diagnosed while admitted in the ICU in 46% of patients. Urology related cases were all diagnosed in the general ward. Multiple surgical procedures were done in 60% of abdominal surgery patients. Antibiotics were administered prior to candidemia in 87% of patients, with median duration 17 (1-108) days. Neutropenia was less common than expected in patients with candidemia (8/105) and closely associated to haematological malignancy (6/8). Compared with previous national figures the epidemiology of invasive candidiasis seems not to have changed over the last decade.

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Thirty days cummulative survival according to clinical recognisable categories.IDU and Urology compated to all other categories (Other surgery, Abdominal surgery, Other medical, Pneumonia, Hematology). * Log rank test p = 0,0425.
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pone-0103916-g001: Thirty days cummulative survival according to clinical recognisable categories.IDU and Urology compated to all other categories (Other surgery, Abdominal surgery, Other medical, Pneumonia, Hematology). * Log rank test p = 0,0425.

Mentions: 110 individual patients with candidemia were identified over the 11 years period, several with multiple positive cultures, giving an incidence of 2, 6/100000 citizens/year of unique episodes. Candida albicans was by far most prevalent, species distribution and susceptibility patterns are shown in table 1. Candidemia incidence proportions per 1000 discharged patients from general Medical, Haematological, Gastro-surgical, and Urology- wards are shown in table 2. Patients received anti-fungal therapy according to susceptibility results, except in 28 cases were blood cultures became positive on the day of death or thereafter (n = 20), or the candidemia was considered a terminal event and treatment refrained (n = 8). Another 7 patients were discharged untreated before candidemia was recognized, all cases without clinical consequences (Table 3). Fluconazol was the most used empirical antifungal, with an increased use of ecchinocandins empirically towards the end of the period, rapidly de-escalating to fluconazole in stable patients. Except in a few selected haematological patients, antifungals were not used for prophylaxis. Thirty days case fatality rate was 49%, and one-year mortality was 64%. Analysing survival according to clinical categories revealed three distinct patterns, with the clinical categories Intravenous Drug Use (IDU) (30 days case fatality 0) and Urology (30 days case fatality 0,29) having significant lesser case fatality than all other categories (30 days case fatality 0,50–0,62). A Kaplan Meier plot is depicted in figure 1. Follow-up for 90 and 1 year did not change this pattern (data not shown). Advanced or incurable cancer was present in 15 patients in the 30 days non survivors group, and in 5 surviving 30 days, median survival in this latter group was 82 days, and only one survived more than a year (range 38–485 days). Median age in non-survivors at 30 days was 74 years (range 31–93) versus 65 years (range 24–92) in survivors. Distribution of antibiotic days prior to candidemia and other established risk factors are shown in table 4. Mean SAPS II score in the ICU candedima patients was 49 (SD 15). Catheter related candidemia was diagnosed in13 patients (12%), evenly distributed between the clinical recognisable category Pneumonia and Haematological. Within the Gastro-surgery category perforated viscus or anastomosis leakage were present in18/37 (49%) and pancreatitis in 5/37 (13%) patients. 22/37 (59%) of patients underwent at least 2 abdominal surgical procedures before or shortly after occurrence of candidemia. In 10/37 (27%) patients between 3 and 8 surgical procedures were performed. Among the patients categorised in the Urology category 11/14 (79%) had obstructive uropathy with a foreign body, 9/14 (64%) either replaced or got a new nephrostomy in close temporal relation to the candidemia.


Nosocomial candidemia; risk factors and prognosis revisited; 11 years experience from a Norwegian secondary hospital.

Berdal JE, Haagensen R, Ranheim T, Bjørnholt JV - PLoS ONE (2014)

Thirty days cummulative survival according to clinical recognisable categories.IDU and Urology compated to all other categories (Other surgery, Abdominal surgery, Other medical, Pneumonia, Hematology). * Log rank test p = 0,0425.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4117589&req=5

pone-0103916-g001: Thirty days cummulative survival according to clinical recognisable categories.IDU and Urology compated to all other categories (Other surgery, Abdominal surgery, Other medical, Pneumonia, Hematology). * Log rank test p = 0,0425.
Mentions: 110 individual patients with candidemia were identified over the 11 years period, several with multiple positive cultures, giving an incidence of 2, 6/100000 citizens/year of unique episodes. Candida albicans was by far most prevalent, species distribution and susceptibility patterns are shown in table 1. Candidemia incidence proportions per 1000 discharged patients from general Medical, Haematological, Gastro-surgical, and Urology- wards are shown in table 2. Patients received anti-fungal therapy according to susceptibility results, except in 28 cases were blood cultures became positive on the day of death or thereafter (n = 20), or the candidemia was considered a terminal event and treatment refrained (n = 8). Another 7 patients were discharged untreated before candidemia was recognized, all cases without clinical consequences (Table 3). Fluconazol was the most used empirical antifungal, with an increased use of ecchinocandins empirically towards the end of the period, rapidly de-escalating to fluconazole in stable patients. Except in a few selected haematological patients, antifungals were not used for prophylaxis. Thirty days case fatality rate was 49%, and one-year mortality was 64%. Analysing survival according to clinical categories revealed three distinct patterns, with the clinical categories Intravenous Drug Use (IDU) (30 days case fatality 0) and Urology (30 days case fatality 0,29) having significant lesser case fatality than all other categories (30 days case fatality 0,50–0,62). A Kaplan Meier plot is depicted in figure 1. Follow-up for 90 and 1 year did not change this pattern (data not shown). Advanced or incurable cancer was present in 15 patients in the 30 days non survivors group, and in 5 surviving 30 days, median survival in this latter group was 82 days, and only one survived more than a year (range 38–485 days). Median age in non-survivors at 30 days was 74 years (range 31–93) versus 65 years (range 24–92) in survivors. Distribution of antibiotic days prior to candidemia and other established risk factors are shown in table 4. Mean SAPS II score in the ICU candedima patients was 49 (SD 15). Catheter related candidemia was diagnosed in13 patients (12%), evenly distributed between the clinical recognisable category Pneumonia and Haematological. Within the Gastro-surgery category perforated viscus or anastomosis leakage were present in18/37 (49%) and pancreatitis in 5/37 (13%) patients. 22/37 (59%) of patients underwent at least 2 abdominal surgical procedures before or shortly after occurrence of candidemia. In 10/37 (27%) patients between 3 and 8 surgical procedures were performed. Among the patients categorised in the Urology category 11/14 (79%) had obstructive uropathy with a foreign body, 9/14 (64%) either replaced or got a new nephrostomy in close temporal relation to the candidemia.

Bottom Line: Urology related cases were all diagnosed in the general ward.Multiple surgical procedures were done in 60% of abdominal surgery patients.Compared with previous national figures the epidemiology of invasive candidiasis seems not to have changed over the last decade.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, Akershus University Hospital, Nordbyhagen, Norway.

ABSTRACT
The aim of the study was to review the epidemiology and prognosis of candidemia in a secondary hospital, and to examine the intra-hospital distribution of candidemia patients. Study design is a retrospective cohort study. Trough 2002-2012, 110 cases of candidemia were diagnosed, giving an incidence of 2, 6/100,000 citizens/year. Overall prognosis of candidemia was dismal, with a 30 days case fatality rate of 49% and one year case fatality rate of 64%. Candidemia was a terminal event in 55% of 30 days non-survivors, defined as Candida blood cultures reported positive on the day of death or thereafter (39%), or treatment refrained due to hopeless short-term prognosis (16%). In terminal event candidemias, advanced or incurable cancer was present in 29%. Non-survivors at 30 days were 9 years (median) older than survivors. In 30 days survivors, candidemia was not recognised before discharge in 13% of cases. No treatment were given and no deaths or complications were observed in this group. Candidemia patients were grouped into 8 patient categories: Abdominal surgery (35%), urology (13%), other surgery (11%), pneumonia (13%), haematological malignancy (7%), intravenous drug abuse (4%), other medical (15%), and new-borns (3%). Candidemia was diagnosed while admitted in the ICU in 46% of patients. Urology related cases were all diagnosed in the general ward. Multiple surgical procedures were done in 60% of abdominal surgery patients. Antibiotics were administered prior to candidemia in 87% of patients, with median duration 17 (1-108) days. Neutropenia was less common than expected in patients with candidemia (8/105) and closely associated to haematological malignancy (6/8). Compared with previous national figures the epidemiology of invasive candidiasis seems not to have changed over the last decade.

Show MeSH
Related in: MedlinePlus