Epidemiology of candidemia and impact of infectious disease consultation on survival and care

• Published in: Infection 2020-04, Vol.48 (2), p.275-284
• Main Authors: Mohr, Arno, Simon, Michaela, Joha, Tobias, Hanses, Frank, Salzberger, Bernd, Hitzenbichler, Florian
• Format: Article
• Language: English
• Subjects: Aged; Candida - classification; Candida - isolation & purification; Candida - physiology; Candidemia; Candidemia - diagnosis; Candidemia - drug therapy; Candidemia - epidemiology; Candidemia - mortality; Catheters; Cohort Studies; Diagnostic systems; Epidemiology; Family Medicine; Female; Gender; General Practice; Germany - epidemiology; Hospitals - statistics & numerical data; Humans; Infectious Diseases; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Multivariate analysis; Original Paper; Patients; Referral and Consultation - standards; Regression analysis; Retrospective Studies; Risk analysis; Risk Factors; Survival
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-020-01393-9

Background The aim of this study was to analyse temporal changes in the epidemiology of candidemia assessing patient’s characteristics, risk factors, diagnostic management, treatment, and outcome in a tertiary care hospital in South Eastern Germany. Methods In this retrospective cohort study patients with blood cultures positive for Candida spp. were identified from the microbiological database in the years 2006–2018. A detailed collection of patients’ characteristics was obtained for the time periods 2006–2008 and 2016–2018. Risk factors for survival were analysed in a logistic regression analysis. Results In the years 2006–2018, a total of 465 episodes of candidemia were identified. An increase in candidemia cases was evident in the period of 2016–2018 compared to 2006–2015 and to 2006–2008 in absolute numbers and adjusted to patient-days. C. albicans was responsible for 62.8% of cases in 2006–2008 and 51.2% of all cases in the years 2016–2018, respectively, whereas there was a significant increase of C. glabrata in the latter period (16.3–31.5%). Overall mortality was not significantly different in the two periods. Infectious diseases consultation led to a lower mortality of patients with candidemia and to a higher adherence to guidelines. In multivariate analysis, only complete change or extraction of intravascular indwelling material and female gender were independent predictors for survival. Conclusion We observed an increase in candidemia rates and rates of non- albicans spp. over time. A complete change of all catheters and/or indwelling devices improved survival. ID consultation led to a better guideline adherence.