Dataset Information

Risk Factors for Mortality in Colombian Patients with Candidemia.

ABSTRACT: The aim of the study was to describe the microbiology and susceptibility profile of candidemia and to identify the risk factors associated with mortality in Colombia. A cohort of patients was followed for 30 days during 2008 to 2010. Microbiological identification and susceptibility assessments were performed in a reference centre. Demographic, clinical and treatment variables were evaluated for their associations with mortality. A parametric survival regression analysis was used to identify the risk factors associated with mortality. A total of 109 patients with candidemia in four hospitals in Colombia were identified, with a median age of 30 years old. C. parapsilosis was the most frequently identified microorganism (38.5%); the susceptibility of all isolates was high to fluconazole and anidulafungin, except for C. glabrata isolates. The overall mortality was 35.7%, and the risk factors associated with mortality included lack of antifungal treatment (HR 5.5, 95% CI 3.6-11.4), cancer (HR 3.9, 95% CI 2.3-8.0), diabetes (HR 2.5, 95% CI 1.03-6.4), and age (HR 1.13 per every 10 years, 95% CI 1.02-1.24). Catheter removal was associated with a low mortality rate (HR 0.06, 95% CI 0.00-0.49). Prompt antifungal treatment, better glycemic control and catheter removal should be prioritized in the management of candidemia.

SUBMITTER: Cortes JA

PROVIDER: S-EPMC8229794 | biostudies-literature | 2021 May

REPOSITORIES: biostudies-literature

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Risk Factors for Mortality in Colombian Patients with Candidemia.

Cortés Jorge Alberto JA Montañez Anita María AM Carreño-Gutiérrez Ana María AM Reyes Patricia P Gómez Carlos Hernando CH Pescador Angela A Ariza Beatriz B Rosso Fernando F

Journal of fungi (Basel, Switzerland) 20210531 6

The aim of the study was to describe the microbiology and susceptibility profile of candidemia and to identify the risk factors associated with mortality in Colombia. A cohort of patients was followed for 30 days during 2008 to 2010. Microbiological identification and susceptibility assessments were performed in a reference centre. Demographic, clinical and treatment variables were evaluated for their associations with mortality. A parametric survival regression analysis was used to identify the ...[more]

PMID: 34073125

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Project description:BackgroundData on persistent candidemia (PC), a recognized complication of candidemia, are lacking in China. This study aimed to investigate the clinical characteristics and risk factors for the mortality of PC among adults in China.MethodsThis 6-year retrospective study analyzed the prevalence, species distribution, antifungal susceptibility, risk factors, and patient mortality of PC among adults in three regional tertiary teaching hospitals in China from 2016 to 2021. We collected electronic laboratory records data of PC and non-PC patients and used the Student test or Mann-Whitney U test for a retrospective study. Logistic regression was used to identify risk factors associated with persistent candidemia.ResultsThe definition of PC was fulfilled by 36 patients (13.7%, 36/263). The mean age of the patients was 59.9 years (60 years for patients with PC; 59.8 years for those with non-PC; P > 0.05) and 131 (60.1%) were men [16 with PC (44.4%), 115 with non-PC (63.2%), P < 0.05]. The mean annual incidence was 0.15/1000 admissions (including PC 0.03/1000 admissions vs. non-PC 0.12/1000 admissions, P < 0.05). Candida parapsilosis (14/36, 38.9%) and Candida albicans (81/182, 44.5%) were the predominant pathogens in patients with PC and non-PC, respectively. Most isolates were susceptible to flucytosine (99.0%) and amphotericin B (99.5%), and the activity of antifungal agents against Candida species was not statistically significantly different between patients with PC and non-PC (P > 0.05). The 30-day mortality rate was 20.2% (16.7% with PC vs. 20.9% with non-PC, P > 0.05). Multivariable regression analysis showed that use of broad-spectrum antibiotics (odds ratio (OR), 5.925; 95% confidence interval (CI), 1.886-18.616, P = 0.002), fluconazole (OR, 3.389; 95% CI, 1.302-8.820, P = 0.012) and C. parapsilosis infection (OR, 6.143; 95% CI, 2.093-18.031, P = 0.001) were independent predictors of PC, sex (male) (OR, 0.199; 95% CI, 0.077-0.518, P = 0.001) was the protective factor for PC. Respiratory dysfunction (OR, 5.763; 95% CI, 1.592-20.864, P = 0.008) and length of hospital stay(OR, 0.925; 95% CI, 0.880-0.973, P = 0.002) were independent predictors of 30-day mortality in patients with non-PC. C. tropicalis bloodstream infection (OR, 12.642; 95% CI, 1.059-150.951; P = 0.045) was an independent predictor of 30-day mortality in patients with PC.ConclusionsThe epidemiological data of patients with PC and non-PC were different in the distribution of Candida species, the mean annual incidence and independent predictors of 30-day mortality. Flucytosine and amphotericin B could be used as first-choice drugs in the presence of PC infections.

Project description:AimThe study of candidemia in cancer patients has been limited. This retrospective study aims to investigate the epidemiologic characteristics and prognostic factors of candidemia among cancer patients.Materials and methodsFrom 2009 to 2012, cancer patients with candidemia were identified at a hospital in Taiwan. The medical records of all patients with bloodstream infections due to Candida species were retrospectively reviewed.ResultsDuring the four-year period, a total of 242 episodes of candidemia were identified among cancer patients. Half of these patients were classified as elderly (≥65 years old), and more than 95% of the candidemia episodes were classified as healthcare-associated infections. Among the 242 cancer patients with candidemia, head and neck cancer was the most common, followed by gastrointestinal tract and lung cancer. Additionally, most of the patients had variable underlying conditions, such as the presence of CVC (99%) or prior exposure to broad-spectrum antibiotics (93%) and were receiving an immunosuppressant (86%). Overall, C. albicans (n = 132, 54.5%) was the most common pathogen, followed by C. tropicalis (n = 52, 21.5%), C. parapsilosis (n = 38, 15.7%), and C. glabrata (n = 29, 12.0%). Seventeen patients had polycandidal candidemia, and 77 patients had concomitant bacteremia. Approximately one-third of the patients required admission to the intensive care unit (ICU) or mechanical ventilation, and the overall in-hospital mortality was 50.8%. Multivariable analysis showed that the in-hospital mortality was significantly associated with only the non-use of antifungal agents and acute respiratory failure (P<.001).ConclusionsCandidemia can develop in patients with both solid cancer and hematological malignancy, especially for patients with underlying conditions. Overall, the associated morbidity and mortality due to Candidemia remain high. It was also determined that the non-use of antifungal agents and acute respiratory failure conditions were associated with in-hospital mortality.

Project description:BackgroundBovine brucellosis is a zoonotic disease that causes substantial economic losses and has a strong impact on public health. The main objective of this paper is to determine the risk factors for new infections of Brucella abortus on Colombian cattle farms previously certified as being free of brucellosis. A case-control study was conducted by comparing 98 cases (farms certified as brucellosis-free for three or more years but became infected) with 93 controls (farms that remained brucellosis-free during at least the previous three years). The farms were matched by herd size and geographical location (municipality). Information was obtained via a questionnaire completed by veterinary officers through a personal interview with the herd owners.ResultsTwo-thirds of the herds (67%) were dairy herds, 16% were beef herds, and 17% were dual-purpose (beef and milk) herds. After exploratory univariate analysis, all explanatory variables with a p-value of ≤0.20 were included in a logistic regression model using the forward stepwise method to select the model with the best goodness of fit. The significant risk factors were the replacement of animals from farms not certified as brucellosis-free compared to replacement from certified brucellosis-free farms (OR = 4.84, p-value < 0.001) and beef cattle farms compared to dairy cattle farms (OR = 3.61, p-value = 0.017). When herds with and without artificial insemination were compared, it was observed that farms that used natural breeding with bulls from non-certified herds had a higher risk than farms using artificial insemination (OR = 2.45, p-value = 0.037), but when the bulls came from brucellosis-free farms, farms with natural breeding were less affected (OR = 0.30, p-value = 0.004) than farms using artificial insemination, whether with frozen semen from certified brucellosis-free herds or fresh semen from uncontrolled herds. The latter is commonly sold to neighbouring farms.ConclusionsThe government should make efforts to inform farmers about the risks involved in the introduction of semen and replacement heifers from farms that are not certified as brucellosis-free and to establish measures to control these practices.

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Risk Factors for Mortality in Colombian Patients with Candidemia.

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Risk Factors for Mortality in Colombian Patients with Candidemia.

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