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

Autor(es)

Agnelli, Caroline ; Valerio, Maricela ; Bouza, Emilio ; Guinea, Jesus ; Sukiennik, Teresa ; Guimaraes, Thais ; Queiroz-Telles, Flavio ; Munoz, Patricia ; Colombo, Arnaldo Lopes

• Tipo de documento: Artigo Científico
• Fonte: LANCET REGIONAL HEALTH-AMERICAS; v. 6, p. 9-pg., 2022-02-01.

Resumo

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 center dot 5% vs. 39 center dot 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 center dot 8% vs. 20 center dot 1%, p< 0.001), and at 30 days (51 center dot 9% vs. 31 center dot 6%, p < 0.001). Factors associated with mortality included: age [OR 1 center dot 02, 95%CI (1 center dot 008-1 center dot 032), p = 0 center dot 001], neutropenia [OR 3 center dot 24, 95%CI (1 center dot 594-6 center dot 585), p = 0 center dot 001], chronic pulmonary disease [OR 2 center dot 26, 95%CI (1 center dot 495-3 center dot 436), p < 0 center dot 001], corticosteroids [OR 1 center dot 45, 95%CI (1 center dot 018-2 center dot 079), p = 0 center dot 039], PittScore>1 [OR 2 center dot 56, 95%CI (1 center dot 776-3 center dot 690), p < 0 center dot 001], and inadequate therapeutic management [OR 2 center dot 84, 95%CI (1 center dot 685-4 center dot 800), p < 0 center dot 001]. Being from Spain [OR 0 center dot 51, 95%CI (0 center dot 359-0 center dot 726), p < 0 center dot 001] and C. parapsilosis [OR 0 center dot 36, 95%CI (0 center dot 233-0 center dot 568), p < 0 center dot 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. Copyright (c) 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/) (AU)

• Processo FAPESP: 17/02203-7 - Rede multidisciplinar internacional para caracterização de aspectos microbiológicos e da história natural de Infecções Fúngicas Invasivas (IFI) por espécies do gênero Candida
• Beneficiário: Arnaldo Lopes Colombo
• Modalidade de apoio: Auxílio à Pesquisa - Temático