Factors Influencing Non-albicans Candidemia: A Case–Case–Control Study
The study identified factors predisposing to non-albicans candidemia with special interest to prior antimicrobial treatment. A retrospective, case–case–control study was performed at the University Hospital of Heraklion, Greece, from November 2007 through September 2011 including adult patients. The study had three groups. The first included 58 patients with non-albicans candidemia, the second 48 with C. albicans candidemia, while the third (control) 104 without candidemia. Each of the two candidemia groups was compared with the control using multivariate logistic regression model. The mean (SD) age of the non-albicans, the albicans and the control patients was 67 (12), 67 (18) and 59 (19) years, respectively. The most common non-albicans Candida spp. isolated were C. parapsilosis in 19 patients (33%), C. glabrata in 17 (29%) and C. tropicalis in 15 (26%). Independent risk factors for non-albicans candidemia were prior treatment with quinolones (p < 0.001), b-lactam-b-lactamase inhibitors (p = 0.011) and presence of central venous catheter (p = 0.05), while for C. albicans candidemia were prior treatment with quinolones (p < 0.001), carbapenems (p = 0.003) along with cardiac disease (p < 0.001). Neither duration of hospitalization nor in-hospital mortality [41% for the non-albicans vs 29% for C. albicans group (p = 0.192)] was significantly different between the two candidemia groups. The study reveals the role of antimicrobial exposure as a risk factor for candidemia caused by different species. Prior treatment with b-lactam-b-lactamase inhibitors was associated with non-albicans, while with carbapenems with C. albicans candidemia. Prior use of quinolones was associated with candidemia in general.
KeywordsCandidemia C. albicans Non-albicans Candida spp. Carbapenems b-Lactam-b-lactamase inhibitors Quinolones
Presented in part at 52nd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC). September 9–12, 2012; San Francisco, California.
This study has been supported by the Hellenic Society for Medical Mycology (Grant number 557A / 07-04-2014).
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Conflict of interest
- 8.Yamamura DL, Rotstein C, Nicole LE, Ioannou S. Candidemia at selected Canadian sites: results from the Fungal Disease Registry, 1992–1994. Fungal Disease Registry of the Canadian Infectious Disease Society. Canadian Med Assoc J. 1999;160:493–9.Google Scholar
- 17.Rodríguez D, Almirante B, Cuenca-Estrella M, Rodríguez-Tudela JL, Mensa J, Ayats J, Sanchez F, Pahissa A, Barcelona Candidemia Project Study Group. Predictors of candidaemia caused by non-albicans Candida species: results of a population-based surveillance in Barcelona, Spain. Clin Microbiol Infect. 2010;16:1676–82.CrossRefPubMedGoogle Scholar