Epidemiology and Outcomes of Candidemia in 2019 Patients: Data from the Prospective Antifungal Therapy Alliance Registry
Abstract
BACKGROUND: Candidemia remains a major cause of morbidity and mortality in the health care setting, and the epidemiology of Candida infection is changing. METHODS: Clinical data from patients with candidemia were extracted from the Prospective Antifungal Therapy (PATH) Alliance database, a comprehensive registry that collects information regarding invasive fungal infections. A total of 2019 patients, enrolled from 1 July 2004 through 5 March 2008, were identified. Data regarding the candidemia episode were analyzed, including the specific fungal species and patient survival at 12 weeks after diagnosis. RESULTS: The incidence of candidemia caused by non-Candida albicans Candida species (54.4%) was higher than the incidence of candidemia caused by C. albicans (45.6%). The overall, crude 12-week mortality rate was 35.2%. Patients with Candida parapsilosis candidemia had the lowest mortality rate (23.7%; P<.001) and were less likely to be neutropenic (5.1%; P<.001) and to receive corticosteroids (33.5%; P<.001) or other immunosuppressive drugs (7.9%; P=.002), compared with patients infected with other Candida species. Candida krusei candidemia was most commonly associated with prior use of antifungal agents (70.6%; P<.001), hematologic malignancy (52.9%; P<.001) or stem cell transplantation (17.7%; P<.001), neutropenia (45.1%; P<.001), and corticosteroid treatment (60.8%; P<.001). Patients with C. krusei candidemia had the highest crude 12-week mortality in this series (52.9%; P<.001). Fluconazole was the most commonly administered antimicrobial, followed by the echinocandins, and amphotericin B products were infrequently administered. CONCLUSIONS: The epidemiology and choice of therapy for candidemia are rapidly changing. Additional study is warranted to differentiate host factors and differences in virulence among Candida species and to determine the best therapeutic regimen.
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Two RCTs have been published; one failed to achieve a difference in time-to-antimicrobials between arms and the other found no significant difference in mortality despite a 90-minute difference in median time interval to antimicrobial administration.
“Two RCTs have been published (119, 120); one failed to achieve a difference in time-to-antimicrobials between arms (120) and the other found no significant difference in mortality despite a 90-minute difference in median time interval to antimicrobial administration (119).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [119]
Observational studies suggest that mortality may increase after intervals exceeding 3-5 hours from hospital arrival and/or sepsis recognition.
“Observational studies do, however, suggest that mortality may increase after intervals exceeding 3-5 hours from hospital arrival and/or sepsis recognition (98,111,119,120).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [119]
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- Authors
- Horn, D. L., Neofytos, D., Anaissie, E. J., Fishman, J. A., Steinbach, W. J., Olyaei, A. J., Marr, K. A., Pfaller, M. A., Chang, C., & Webster, K. M.
- Affiliations
- Thomas Jefferson University (US)
- University of Arkansas for Medical Sciences (US)
- Massachusetts General Hospital (US)
- Duke Medical Center (US)
- Oregon Health & Science University (US)
- Johns Hopkins University (US)
- University of Iowa Health Care (US)
- Corresponding author
- Horn, David L.
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-06-15
- Volume
- 48
- Issue
- 12
- Pages
- 1695-1703
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2117166221
- Cited by
- 956
- References
- 9
- Citations by year
- 2026: 11 · 2025: 26 · 2024: 30 · 2023: 33 · 2022: 36 · 2021: 58 · 2020: 57 · 2019: 64 · 2018: 55 · 2017: 61 · 2016: 65 · 2015: 70 · 2014: 81 · 2013: 86 · 2012: 79
- FWCI
- 50.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- The Medicine Forum (submittedVersion)
- Funders
- Massachusetts General Hospital
- University of Miami
- University of Pennsylvania
- Emory University
- Bunning Food Allergy Institute, Ann and Robert H. Lurie Children's Hospital of Chicago
- University of Minnesota
- University of Washington
- Johns Hopkins University
- University of Pittsburgh
- Thomas Jefferson University
- City of Hope
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Yeasts and Rust Fungi Studies
- Keywords
- candidemia, invasive fungal infections, non-albicans Candida, Candida albicans, Candida parapsilosis, Candida krusei, mortality, neutropenia, corticosteroids, antifungal therapy, fluconazole, echinocandins, amphotericin B, hematologic malignancies, stem cell transplantation, epidemiology
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Amphotericin B, Antifungal Agents, Candida, Candidiasis, Child, Child, Preschool, Cross Infection, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Fluconazole, Incidence, Survival Analysis, Fungemia, Treatment Outcome, Echinocandins, Young Adult
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