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Open Access Highly Accessed Research article

Risk factors for fatal candidemia caused by Candida albicans and non-albicans Candida species

Ming-Fang Cheng1234, Yun-Liang Yang5, Tzy-Jyun Yao6, Chin-Yu Lin6, Jih-Shin Liu6, Ran-Bin Tang2, Kwok-Woon Yu3, Yu-Hua Fan7, Kai-Sheng Hsieh1, Monto Ho8 and Hsiu-Jung Lo8*

Author Affiliations

1 Department of Pediatrics, Veterans General Hospital-Kaohsiung, Kaohsiung, Taiwan

2 Section of Infection Disease, Department of Pediatrics, Taiwan

3 Department of Microbiology, Veterans General Hospital-Taipei, Taiwan

4 National Yang Ming University, Taipei, Taiwan

5 Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan

6 Division of Biostatistics and Bioinformatics, Miaoli, Taiwan

7 Koahsiung Medical University, Kaohsiung, Taiwan

8 Division of Clinical Research, National Health Research Institutes, Miaoli, Taiwan

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BMC Infectious Diseases 2005, 5:22  doi:10.1186/1471-2334-5-22

Published: 7 April 2005

Abstract

Background

Invasive fungal infections, such as candidemia, caused by Candida species have been increasing. Candidemia is not only associated with a high mortality (30% to 40%) but also extends the length of hospital stay and increases the costs of medical care. Sepsis caused by Candida species is clinically indistinguishable from bacterial infections. Although, the clinical presentations of the patients with candidemia caused by Candida albicans and non-albicans Candida species (NAC) are indistinguishable, the susceptibilities to antifungal agents of these species are different. In this study, we attempted to identify the risk factors for candidemia caused by C. albicans and NAC in the hope that this may guide initial empiric therapy.

Methods

A retrospective chart review was conducted during 1996 to 1999 at the Veterans General Hospital-Taipei.

Results

There were 130 fatal cases of candidemia, including 68 patients with C. albicans and 62 with NAC. Candidemia was the most likely cause of death in 55 of the 130 patients (42.3 %). There was no significant difference in the distribution of Candida species between those died of candidemia and those died of underlying conditions. Patients who had one of the following conditions were more likely to have C. albicans, age ≧ 65 years, immunosuppression accounted to prior use of steroids, leukocytosis, in the intensive care unit (ICU), and intravascular and urinary catheters. Patients who had undergone cancer chemotherapy often appeared less critically ill and were more likely to have NAC.

Conclusion

Clinical and epidemiological differences in the risk factors between candidemia caused by C. albicans and NAC may provide helpful clues to initiate empiric therapy for patients infected with C. albicans versus NAC.