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Clinical characteristics and predictors of mortality in cirrhotic patients with candidemia and intra-abdominal candidiasis: a multicenter study

2017; Springer Science+Business Media; Volume: 43; Issue: 4 Linguagem: Inglês

10.1007/s00134-017-4717-0

1432-1238

Matteo Bassetti, Maddalena Peghin, Alessia Carnelutti, Elda Righi, Maria Merelli, Filippo Ansaldi, Cecilia Trucchi, Cristiano Alicino, Assunta Sartor, Pierluigi Toniutto, Joost Wauters, Wim Laleman, Carlo Tascini, Francesco Menichetti, Roberto Luzzati, Pierluigi Brugnaro, Alessio Mesini, Stefania Raviolo, Francesco Giuseppe De Rosa, Leonel Lagunes, Jordi Rello, George Dimοpoulos, Arnaldo Lopes Colombo, Márcio Nucci, Antonio Vena, Emilio Bouza, Patricia Muñóz, Mario Tumbarello, Raffaella Losito, Ignacio Martín‐Loeches, Claudio Viscoli,

Amoebic Infections and Treatments

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.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.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.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.