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

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.



Autori interni: 
MENICHETTI, FRANCESCO
mostra contributor esterni 
Autori: Bassetti, Matteo; Peghin, Maddalena; Carnelutti, Alessia; Righi, Elda; Merelli, Maria; Ansaldi, Filippo; Trucchi, Cecilia; Alicino, Cristiano; Sartor, Assunta; Toniutto, Pierluigi; Wauters, Joost; Laleman, Wim; Tascini, Carlo; MENICHETTI, FRANCESCO; Luzzati, Roberto; Brugnaro, Pierluigi; Mesini, Alessio; Raviolo, Stefania; De Rosa, Francesco G.; Lagunes, Leonel; Rello, Jordi; Dimopoulos, George; Colombo, Arnaldo L.; Nucci, Marcio; Vena, Antonio; Bouza, Emilio; Muã±oz, Patricia; Tumbarello, Mario; Losito, Raffaella; Martin Loeches, Ignacio; Viscoli, Claudio
Titolo: Clinical characteristics and predictors of mortality in cirrhotic patients with candidemia and intra-abdominal candidiasis: a multicenter study
Anno del prodotto: 2017
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.
Digital Object Identifier (DOI): 10.1007/s00134-017-4717-0
Appare nelle tipologie:1.1 Articolo in rivista

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http://hdl.handle.net/11568/871519
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