Prognostic factors of Candida spp. bloodstream infection in adults: A nine-year retrospective cohort study across tertiary hospitals in Brazil and Spain

Summary: Background: Mortality rates among adults with candidemia vary widely in different geographical settings. Studies directly comparing epidemiology and clinical practices between countries are scarce and could bring insights into improving clinical outcomes. Methods: Retrospective cohort incl...

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Autores principales:	Caroline Agnelli, Maricela Valerio, Emilio Bouza, Jesús Guinea, Teresa Sukiennik, Thais Guimarães, Flavio Queiroz-Telles, Patricia Muñoz, Arnaldo Lopes Colombo
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2022
Materias:	Candidemia Invasive candidiasis Prognostic factors Antifungal treatment Echinocandins Intravascular catheter Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/f02cf9e2a654439ea54c8587c646fa85
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spelling	oai:doaj.org-article:f02cf9e2a654439ea54c8587c646fa852021-12-02T05:04:42ZPrognostic factors of Candida spp. bloodstream infection in adults: A nine-year retrospective cohort study across tertiary hospitals in Brazil and Spain2667-193X10.1016/j.lana.2021.100117https://doaj.org/article/f02cf9e2a654439ea54c8587c646fa852022-02-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2667193X21001137https://doaj.org/toc/2667-193XSummary: Background: Mortality rates among adults with candidemia vary widely in different geographical settings. Studies directly comparing epidemiology and clinical practices between countries are scarce and could bring insights into improving clinical outcomes. Methods: Retrospective cohort including adults with candidemia diagnosed in five tertiary hospitals from Brazil and Spain between 2010-2018. Adequate therapeutic management included appropriate antifungal therapy and central-venous-catheter (CVC) removal within 48 h of fungemia. Primary endpoints were mortality rates at 14 and 30 days. Secondary endpoints were prognostic factors associated with 30-day mortality. Findings: Overall, 720 patients were included, being 323 from Spain. Spanish patients received echinocandins more often (52·5% vs. 39·3%, p = 0.001), initiated antifungals earlier [2 (0-7) vs. 2 days (0-16), p<0.001], and had faster CVC-removal [1 (0-42) vs. 2 days (0-38), p = 0.012]. Mortality was higher among Brazilians at 14 days (35·8% vs. 20·1%, p<0.001), and at 30 days (51·9% vs. 31·6%, p < 0.001). Factors associated with mortality included: age [OR 1·02, 95%CI (1·008-1·032), p = 0·001], neutropenia [OR 3·24, 95%CI (1·594-6·585), p = 0·001], chronic pulmonary disease [OR 2·26, 95%CI (1·495-3·436), p < 0·001], corticosteroids [OR 1·45, 95%CI (1·018-2·079), p = 0·039], Pitt-Score>1 [OR 2·56, 95%CI (1·776-3·690), p < 0·001], and inadequate therapeutic management [OR 2·84, 95%CI (1·685-4·800), p < 0·001]. Being from Spain [OR 0·51, 95%CI (0·359-0·726), p < 0·001] and C. parapsilosis [OR 0·36, 95%CI (0·233-0·568), p < 0·001] were protective. Interpretation: Higher mortality rates were observed in Brazil. Factors associated with 30-day mortality included mainly epidemiological characteristics and inadequate therapeutic management. Thus, effective and prompt antifungals combined with CVC-removal still need to be emphasized in order to improve the prognosis of adults with candidemia. Funding: Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP 2017/02203-7); CAPES Foundation (PDSE 88881.187981/2018-01).Caroline AgnelliMaricela ValerioEmilio BouzaJesús GuineaTeresa SukiennikThais GuimarãesFlavio Queiroz-TellesPatricia MuñozArnaldo Lopes ColomboElsevierarticleCandidemiaInvasive candidiasisPrognostic factorsAntifungal treatmentEchinocandinsIntravascular catheterPublic aspects of medicineRA1-1270ENThe Lancet Regional Health. Americas, Vol 6, Iss , Pp 100117- (2022)
institution	DOAJ
collection	DOAJ
language	EN
topic	Candidemia Invasive candidiasis Prognostic factors Antifungal treatment Echinocandins Intravascular catheter Public aspects of medicine RA1-1270
spellingShingle	Candidemia Invasive candidiasis Prognostic factors Antifungal treatment Echinocandins Intravascular catheter Public aspects of medicine RA1-1270 Caroline Agnelli Maricela Valerio Emilio Bouza Jesús Guinea Teresa Sukiennik Thais Guimarães Flavio Queiroz-Telles Patricia Muñoz Arnaldo Lopes Colombo Prognostic factors of Candida spp. bloodstream infection in adults: A nine-year retrospective cohort study across tertiary hospitals in Brazil and Spain
description	Summary: Background: Mortality rates among adults with candidemia vary widely in different geographical settings. Studies directly comparing epidemiology and clinical practices between countries are scarce and could bring insights into improving clinical outcomes. Methods: Retrospective cohort including adults with candidemia diagnosed in five tertiary hospitals from Brazil and Spain between 2010-2018. Adequate therapeutic management included appropriate antifungal therapy and central-venous-catheter (CVC) removal within 48 h of fungemia. Primary endpoints were mortality rates at 14 and 30 days. Secondary endpoints were prognostic factors associated with 30-day mortality. Findings: Overall, 720 patients were included, being 323 from Spain. Spanish patients received echinocandins more often (52·5% vs. 39·3%, p = 0.001), initiated antifungals earlier [2 (0-7) vs. 2 days (0-16), p<0.001], and had faster CVC-removal [1 (0-42) vs. 2 days (0-38), p = 0.012]. Mortality was higher among Brazilians at 14 days (35·8% vs. 20·1%, p<0.001), and at 30 days (51·9% vs. 31·6%, p < 0.001). Factors associated with mortality included: age [OR 1·02, 95%CI (1·008-1·032), p = 0·001], neutropenia [OR 3·24, 95%CI (1·594-6·585), p = 0·001], chronic pulmonary disease [OR 2·26, 95%CI (1·495-3·436), p < 0·001], corticosteroids [OR 1·45, 95%CI (1·018-2·079), p = 0·039], Pitt-Score>1 [OR 2·56, 95%CI (1·776-3·690), p < 0·001], and inadequate therapeutic management [OR 2·84, 95%CI (1·685-4·800), p < 0·001]. Being from Spain [OR 0·51, 95%CI (0·359-0·726), p < 0·001] and C. parapsilosis [OR 0·36, 95%CI (0·233-0·568), p < 0·001] were protective. Interpretation: Higher mortality rates were observed in Brazil. Factors associated with 30-day mortality included mainly epidemiological characteristics and inadequate therapeutic management. Thus, effective and prompt antifungals combined with CVC-removal still need to be emphasized in order to improve the prognosis of adults with candidemia. Funding: Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP 2017/02203-7); CAPES Foundation (PDSE 88881.187981/2018-01).
format	article
author	Caroline Agnelli Maricela Valerio Emilio Bouza Jesús Guinea Teresa Sukiennik Thais Guimarães Flavio Queiroz-Telles Patricia Muñoz Arnaldo Lopes Colombo
author_facet	Caroline Agnelli Maricela Valerio Emilio Bouza Jesús Guinea Teresa Sukiennik Thais Guimarães Flavio Queiroz-Telles Patricia Muñoz Arnaldo Lopes Colombo
author_sort	Caroline Agnelli
title	Prognostic factors of Candida spp. bloodstream infection in adults: A nine-year retrospective cohort study across tertiary hospitals in Brazil and Spain
title_short	Prognostic factors of Candida spp. bloodstream infection in adults: A nine-year retrospective cohort study across tertiary hospitals in Brazil and Spain
title_full	Prognostic factors of Candida spp. bloodstream infection in adults: A nine-year retrospective cohort study across tertiary hospitals in Brazil and Spain
title_fullStr	Prognostic factors of Candida spp. bloodstream infection in adults: A nine-year retrospective cohort study across tertiary hospitals in Brazil and Spain
title_full_unstemmed	Prognostic factors of Candida spp. bloodstream infection in adults: A nine-year retrospective cohort study across tertiary hospitals in Brazil and Spain
title_sort	prognostic factors of candida spp. bloodstream infection in adults: a nine-year retrospective cohort study across tertiary hospitals in brazil and spain
publisher	Elsevier
publishDate	2022
url	https://doaj.org/article/f02cf9e2a654439ea54c8587c646fa85
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Prognostic factors of Candida spp. bloodstream infection in adults: A nine-year retrospective cohort study across tertiary hospitals in Brazil and Spain

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