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- Title
Clinical characteristics and predictors of mortality in cirrhotic patients with candidemia and intra-abdominal candidiasis: a multicenter study.
- Authors
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; Rosa, Francesco; Lagunes, Leonel
- Abstract
<bold>Purpose: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
EUROPE; MORTALITY; CIRRHOSIS of the liver; CANDIDEMIA; CANDIDIASIS; SEPTIC shock; PEPTIDES; ANTIFUNGAL agents; CANDIDA; COMPARATIVE studies; CROSS infection; INTENSIVE care units; RESEARCH methodology; MEDICAL cooperation; MULTIVARIATE analysis; RESEARCH; TIME; COMORBIDITY; EVALUATION research; RETROSPECTIVE studies; INTRA-abdominal infections; DISEASE complications; THERAPEUTICS
- Publication
Intensive Care Medicine, 2017, Vol 43, Issue 4, p509
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-017-4717-0