Clinical characteristics and predictors of mortality in cirrhotic patients with candidemia and intra-abdominal candidiasis: a multicenter study

Mario Tumbarello, Matteo Bassetti, Maddalena Peghin, Alessia Carnelutti, Elda Righi, Maria Merelli, Filippo Ansaldi, Cecilia Trucchi, Cristiano Alicino, Assunta Sartor, Pierluigi Toniutto, Joost Wauters, Wim Laleman, Carlo Tascini, Francesco Menichetti, Roberto Luzzati, Pierluigi Brugnaro, Alessio Mesini, Stefania Raviolo, Francesco G. De RosaLeonel Lagunes, Jordi Rello, George Dimopoulos, Arnaldo L. Colombo, Marcio Nucci, Antonio Vena, Emilio Bouza, Patricia Muñoz, Ignacio Martin-Loeches, Claudio Viscoli

Risultato della ricerca: Contributo in rivistaArticolo in rivista

27 Citazioni (Scopus)

Abstract

Purpose: The aim of the study was to describe the characteristics of cirrhotic patients with candidemia and intra-abdominal candidiasis (IAC) and to evaluate the risk factors associated with 30-day mortality. Methods: A multicenter multinational retrospective study including all consecutive episodes of candidemia and IAC in adult patients with liver cirrhosis in 14 European hospitals during the period 2011–2013 was performed. Results: A total of 241 episodes (169 candidemia, 72 IAC) were included. Most Candida infections were acquired in hospital (208, 86.3%), mainly in the intensive care unit (ICU) (121, 50.2%). At clinical presentation, fever was seen in 60.6% of episodes (146/241) and septic shock in 34.9% (84/241). C. albicans was the most common species (found in 131 episodes, 54.4%), followed by C. glabrata (35, 14.5%) and C. parapsilosis (34, 14.1%). Overall, the 30-day mortality was 35.3%. Multivariable analysis identified candidemia (OR 2.2, 95% CI 1.2–4.5) and septic shock (OR 3.2, 95% CI 1.7–6) as independent factors associated with 30-day mortality. Adequate antifungal treatment (OR 0.4, 95% CI 0.3–0.9) was associated with survival benefit. Conclusions: A shift towards increasing prevalence of C. glabrata and C. parapsilosis species in patients with liver disease was documented. Candidemia and IAC were associated with significant mortality in cirrhotic patients. Thirty-day mortality was associated with candidemia and severe clinical presentation, whereas adequate antifungal treatment improved the prognosis.
Lingua originaleEnglish
pagine (da-a)509-518
Numero di pagine10
RivistaIntensive Care Medicine
Volume43
DOI
Stato di pubblicazionePubblicato - 2017

Keywords

  • Aged
  • Antifungal Agents
  • Candida
  • Candidemia
  • Cirrhosis
  • Comorbidity
  • Cross Infection
  • Echinocandins
  • Europe
  • Female
  • Humans
  • Intensive Care Units
  • Intra-abdominal candidiasis
  • Intraabdominal Infections
  • Invasive candidiasis
  • Liver Cirrhosis
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Retrospective Studies
  • Risk Factors
  • Shock, Septic
  • Time Factors

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