Matteo Bassetti1, Maddalena Peghin2, Alessia Carnelutti2, Elda Righi2, Maria Merelli2, Filippo Ansaldi3, Cecilia Trucchi3, Cristiano Alicino3, Assunta Sartor4, Pierluigi Toniutto5, Joost Wauters6, Wim Laleman7, Carlo Tascini8, Francesco Menichetti9, Roberto Luzzati10, Pierluigi Brugnaro11, Alessio Mesini12, Stefania Raviolo13, Francesco G De Rosa13, Leonel Lagunes14, Jordi Rello14, George Dimopoulos15, Arnaldo L Colombo16, Marcio Nucci17, Antonio Vena18, Emilio Bouza18, Patricia Muñoz18, Mario Tumbarello19, Raffaella Losito19, Ignacio Martin-Loeches20, Claudio Viscoli12. 1. Infectious Diseases Division, Santa Maria Misericordia University Hospital and University of Udine, Piazzale S. Maria della Misericordia, n. 15, 33100, Udine, Italy. mattba@tin.it. 2. Infectious Diseases Division, Santa Maria Misericordia University Hospital and University of Udine, Piazzale S. Maria della Misericordia, n. 15, 33100, Udine, Italy. 3. IRCCS AOU San Martino-IST, Department of Health Sciences, University of Genoa, Genoa, Italy. 4. Microbiology Unit, Santa Maria Misericordia University Hospital, Udine, Italy. 5. Department of Experimental and Clinical Medicine, University of Udine, Udine, Italy. 6. Medical Intensive Care Unit, University Hospitals Leuven, Department of Microbiology and Immunology, Laboratory for Clinical Infectious and Inflammatory Diseases, University of Leuven, Leuven, Belgium. 7. Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium. 8. First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Napoli, Italy. 9. Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy. 10. Infectious Disease Unit, University Hospital of Trieste, Trieste, Italy. 11. Infectious Diseases Department, Ospedale Civile "SS. Giovanni e Paolo", Venice, Italy. 12. Infectious Disease Clinic, IRCCS San Martino - IST Hospital, Genoa, Italy. 13. Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy. 14. Critical Care, Hospital Vall d'Hebron, Institut de Recerca Vall d'Hebron-UAB, CIBERES, Barcelona, Spain. 15. Department of Critical Care Medicine, Medical School, University of Athens, Athens, Greece. 16. University Hospital, Universidade Federal de São Paulo, São Paulo, Brazil. 17. University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. 18. Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 19. Institute of Microbiology, Catholic University of the Sacred Heart, Rome, Italy. 20. Clinica Malattie Infettive, Università degli Studi di Udine, Azienda Sanitaria Universitaria Integrata, Presidio Ospedaliero "Santa Maria della Misericordia", Piazzale S. Maria della Misericordia n. 15, 33100, Udine, Italy.
Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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