![[ Visit the Fifth Decennial online ]](images/banner.gif)
Friday, March 19, 2010
Grand Hall (Hyatt Regency Atlanta)
Background: Candida spp. are the fourth most common nosocomial bloodstream infection in the USA . Persistent candidemia, in which blood cultures remain positive for Candida despite treatment or removal of central venous catheter (CVC), is frequently used as a surrogate marker for mortality, although no supporting data exist.
Objective: To characterize the epidemiology and risk factors associated with persistent candidemia infections in six hospitals inBrazil , and to understand the association between persistent candidemia and mortality.
Methods: We systematically drew blood cultures on days 3, 5, 7, 14 and 21 on all patients with candidemia from April 2005 – June 2007; blood cultures ordered for clinical necessity were also included. We defined persistent candidemia as having a repeat blood culture positive for Candida species ≥ two days after the incident candidemia. We differentiated persistent candidemia from “recurrent candidemia”, defined as having a repeat blood culture positive for Candida species ≥14 days after the last positive culture with at least one negative blood culture in between. The survival function, probability density function, and hazard function were plotted for the combined study sample. Median survival and failure time were estimated and compared via the Kaplan-Meier method. Bivariate relationship between each variable and the survival time were also examined using the Kaplan-Meier method. The survivorship function was plotted by persistent candidemia status and fitted to four common parametric distributions: exponential, Weibull, lognormal, and gamma.
Results: A total of 266 adults were enrolled in our study, of whom 86 developed persistent candidemia. Median age was 63.5 (range, 18-94 years) and 128 (48%) were male. A CVC was placed in 224 (84%), and 161 (62%) died. Persistent candidemia was demonstrated in 86 (44%), and recurrent candidemia in 2 (1%). On bivariate analysis, having persistent candidemia was associated with poor survival. Furthermore, intubation, surgery, chemotherapy, age>65, and a high APACHE score were also significantly associated with poor survival, while having a pre-existing medical condition, an isolate not susceptible to fluconazole, and not removing the CVC after candidemia were not associated.
Conclusions: This is the first study to evaluate the epidemiology and outcomes of persistent candidemia, which may be associated with mortality. Further analyses to determine preventable factors associated with persistent candidemia are warranted.
Objective: To characterize the epidemiology and risk factors associated with persistent candidemia infections in six hospitals in
Methods: We systematically drew blood cultures on days 3, 5, 7, 14 and 21 on all patients with candidemia from April 2005 – June 2007; blood cultures ordered for clinical necessity were also included. We defined persistent candidemia as having a repeat blood culture positive for Candida species ≥ two days after the incident candidemia. We differentiated persistent candidemia from “recurrent candidemia”, defined as having a repeat blood culture positive for Candida species ≥14 days after the last positive culture with at least one negative blood culture in between. The survival function, probability density function, and hazard function were plotted for the combined study sample. Median survival and failure time were estimated and compared via the Kaplan-Meier method. Bivariate relationship between each variable and the survival time were also examined using the Kaplan-Meier method. The survivorship function was plotted by persistent candidemia status and fitted to four common parametric distributions: exponential, Weibull, lognormal, and gamma.
Results: A total of 266 adults were enrolled in our study, of whom 86 developed persistent candidemia. Median age was 63.5 (range, 18-94 years) and 128 (48%) were male. A CVC was placed in 224 (84%), and 161 (62%) died. Persistent candidemia was demonstrated in 86 (44%), and recurrent candidemia in 2 (1%). On bivariate analysis, having persistent candidemia was associated with poor survival. Furthermore, intubation, surgery, chemotherapy, age>65, and a high APACHE score were also significantly associated with poor survival, while having a pre-existing medical condition, an isolate not susceptible to fluconazole, and not removing the CVC after candidemia were not associated.
Conclusions: This is the first study to evaluate the epidemiology and outcomes of persistent candidemia, which may be associated with mortality. Further analyses to determine preventable factors associated with persistent candidemia are warranted.