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Cited by 181Antifungal resistance and susceptibilityInfective Endocarditis Diagnosis and ManagementFungal Infections and Studies

Treatment-related risk factors for hospital mortality in Candida bloodstream infections

Labelle, Andrew J., Micek, Scott T., Roubinian, Nareg, Kollef, Marin H.·2008·Critical Care Medicine
DOI 10.1097/ccm.0b013e31818b3477
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Abstract

OBJECTIVE: To examine the relationship between treatment-related variables for Candida bloodstream infection and hospital mortality. DESIGN: Retrospective cohort analysis. SETTING: Thousand two hundred-bed academic medical center. PATIENTS: A total of 245 consecutive patients with Candida bloodstream infections who received antifungal therapy. INTERVENTIONS: Identification of treatment-related risk factors: central vein catheter retention, inadequate initial fluconazole dosing, and delayed administration of antifungal therapy. MEASUREMENTS AND MAIN RESULTS: A total of 245 patients with Candida bloodstream infections who received antifungal therapy were identified. One hundred eleven (45.3%) patients were managed in an intensive care unit and analyzed as a separate subgroup. In the hospital cohort, 72 (29.4%) patients died during hospitalization and 40 (36.0%) patients died in the intensive care unit cohort. In the hospital cohort, logistic regression analysis identified Acute Physiology and Chronic Health Evaluation II scores (1-point increments) (adjusted odds ratio [AOR], 1.18; 95% confidence interval [CI], 1.11-1.25; p = 0.003), corticosteroid use at the time a positive blood culture was drawn (AOR, 3.41; 95% CI, 1.96-5.93; p = 0.027), inadequate initial fluconazole dosing (AOR, 3.31; 95% CI, 1.83-6.00; p = 0.044), and retention of a central vein catheter (AOR, 4.85; 95% CI, 2.54-9.29; p = 0.015) as independent determinants of hospital mortality. In the intensive care unit cohort, logistic regression analysis identified Acute Physiology and Chronic Health Evaluation II scores (1-point increments) (AOR, 1.21; 95% CI, 1.14-1.29; p = 0.001), inadequate initial fluconazole dosing (AOR, 9.22; 95% CI, 2.15-19.79; p = 0.004), and retention of a central vein catheter (AOR, 6.21; 95% CI, 3.02-12.77; p = 0.011), as independent determinants of hospital mortality. For both cohorts the incremental presence of treatment-related risk factors was statistically associated with greater hospital mortality. CONCLUSIONS: Treatment-related factors, including retention of central vein catheters and inadequate initial fluconazole dosing, were associated with increased hospital mortality in patients with Candida bloodstream infections. These data suggest that optimization of initial antifungal therapy and removal of central vein catheters may improve the outcomes of patients with Candida bloodstream infections.

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Crossref · 10.1097/ccm.0b013e31818b3477

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  • Venous catheter infection and IC guidelines, including the current IDSA guidelines, recommend removal of any intravascular catheter that is positive for a fungal pathogen (i.e., Candida) based on evidence from large retrospective and observational studies.

    “Venous catheter infection and IC guidelines, including the current IDSA guidelines, recommend removal of any intravascular catheter that is positive for a fungal pathogen (ie, Candida) based on evidence from large retrospective and observational studies.”

    From Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting (2011) · cites this paper as [174]

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Authors
Labelle, A. J., Micek, S. T., Roubinian, N., & Kollef, M. H.
Affiliations
  • Washington University in St. Louis (US)
  • Barnes-Jewish Hospital (US)
ORCID
Venue
Critical Care Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2008-11
Volume
36
Issue
11
Pages
2967-2972
ISSN
0090-3493 (ISSN-L)
DOI
10.1097/ccm.0b013e31818b3477
OpenAlex
W1973009525
Cited by
181
References
24
Citations by year
2026: 1 · 2025: 2 · 2024: 5 · 2023: 4 · 2022: 5 · 2021: 11 · 2020: 8 · 2019: 6 · 2018: 9 · 2017: 9 · 2016: 8 · 2015: 16 · 2014: 10 · 2013: 10 · 2012: 13
FWCI
13.87
Type
journal article
Language
en
Open access
closed
Locations
  • Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
  • Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
Keywords
candidemia, in-hospital mortality, risk factors, antifungal therapy, corticosteroid use, APACHE II score, ICU mortality, non-relapse mortality, invasive candidiasis, septic shock, sepsis mortality, mortality prediction model, prognostic factors
MeSH terms
Antifungal Agents, Candidiasis, Catheterization, Central Venous, Catheters, Indwelling, Female, Humans, Inpatients, Intensive Care Units, Male, Middle Aged, Retrospective Studies, Risk Factors, Cohort Studies, Fluconazole, Fungemia

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