Clinical impact of time to positivity for Candida species on mortality in patients with candidaemia

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Objectives: The time to positivity (TTP) of blood cultures is associated with the microbial load in the blood and prognosis in patients with bloodstream infections caused by various bacterial species. However, relevant information about the TTP for Candida species in candidaemia is limited.We investigated the clinical impact of the TTP on mortality in patients with candidaemia. Methods: All consecutive patients=18 years of age with candidaemia between January 2006 and July 2012 were included. The demographics, clinical and microbiological characteristics, antifungal treatment and outcomes of the patients were collected retrospectively. Results: A total of 152 patientswere identified. The overall mortality rate at 6 weekswas 53%. The median TTP for Candida isolates was 27 h (IQR 19-37 h). A TTP of ≤24 h was significantly related to a higher mortality rate (P=0.021). In a multivariate Cox regression analysis, the Charlson comorbidity index value [adjusted hazard ratio (HR) 1.15, 95% CI 1.02-1.29, P=0.018], sequential organ failure assessment score (adjusted HR 1.23, 95% CI 1.13-1.34, P<0.001), TTP ≤24 h (adjusted HR 2.74, 95% CI 1.51-4.97, P=0.001), timing of appropriate antifungal therapy>72 h (adjusted HR 2.38, 95% CI 1.26-4.51, P=0.008) and persistent candidaemia (adjusted HR 2.50, 95% CI 1.33-4.72, P=0.005) were independently associated with the 6 week mortality rate. Conclusions: A short TTP (≤24 h) for Candida species was independently associated with increased mortality in patients with candidaemia. Additional studies on the relevance of the TTP to clinical outcome in patients with candidaemia are needed.

Original languageEnglish
Article numberdkt256
Pages (from-to)2890-2897
Number of pages8
JournalJournal of Antimicrobial Chemotherapy
Volume68
Issue number12
DOIs
Publication statusPublished - 2013 Dec 1

Fingerprint

Candidemia
Candida
Mortality
Organ Dysfunction Scores
Comorbidity
Regression Analysis
Demography
Infection

Keywords

  • Antifungal therapy
  • Blood cultures
  • Bloodstream infections
  • Outcomes

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Clinical impact of time to positivity for Candida species on mortality in patients with candidaemia. / Kim, Si Hyun; Yoon, Young Kyung; Min, Ja Kim; Sohn, Jang Wook.

In: Journal of Antimicrobial Chemotherapy, Vol. 68, No. 12, dkt256, 01.12.2013, p. 2890-2897.

Research output: Contribution to journalArticle

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title = "Clinical impact of time to positivity for Candida species on mortality in patients with candidaemia",
abstract = "Objectives: The time to positivity (TTP) of blood cultures is associated with the microbial load in the blood and prognosis in patients with bloodstream infections caused by various bacterial species. However, relevant information about the TTP for Candida species in candidaemia is limited.We investigated the clinical impact of the TTP on mortality in patients with candidaemia. Methods: All consecutive patients=18 years of age with candidaemia between January 2006 and July 2012 were included. The demographics, clinical and microbiological characteristics, antifungal treatment and outcomes of the patients were collected retrospectively. Results: A total of 152 patientswere identified. The overall mortality rate at 6 weekswas 53{\%}. The median TTP for Candida isolates was 27 h (IQR 19-37 h). A TTP of ≤24 h was significantly related to a higher mortality rate (P=0.021). In a multivariate Cox regression analysis, the Charlson comorbidity index value [adjusted hazard ratio (HR) 1.15, 95{\%} CI 1.02-1.29, P=0.018], sequential organ failure assessment score (adjusted HR 1.23, 95{\%} CI 1.13-1.34, P<0.001), TTP ≤24 h (adjusted HR 2.74, 95{\%} CI 1.51-4.97, P=0.001), timing of appropriate antifungal therapy>72 h (adjusted HR 2.38, 95{\%} CI 1.26-4.51, P=0.008) and persistent candidaemia (adjusted HR 2.50, 95{\%} CI 1.33-4.72, P=0.005) were independently associated with the 6 week mortality rate. Conclusions: A short TTP (≤24 h) for Candida species was independently associated with increased mortality in patients with candidaemia. Additional studies on the relevance of the TTP to clinical outcome in patients with candidaemia are needed.",
keywords = "Antifungal therapy, Blood cultures, Bloodstream infections, Outcomes",
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T1 - Clinical impact of time to positivity for Candida species on mortality in patients with candidaemia

AU - Kim, Si Hyun

AU - Yoon, Young Kyung

AU - Min, Ja Kim

AU - Sohn, Jang Wook

PY - 2013/12/1

Y1 - 2013/12/1

N2 - Objectives: The time to positivity (TTP) of blood cultures is associated with the microbial load in the blood and prognosis in patients with bloodstream infections caused by various bacterial species. However, relevant information about the TTP for Candida species in candidaemia is limited.We investigated the clinical impact of the TTP on mortality in patients with candidaemia. Methods: All consecutive patients=18 years of age with candidaemia between January 2006 and July 2012 were included. The demographics, clinical and microbiological characteristics, antifungal treatment and outcomes of the patients were collected retrospectively. Results: A total of 152 patientswere identified. The overall mortality rate at 6 weekswas 53%. The median TTP for Candida isolates was 27 h (IQR 19-37 h). A TTP of ≤24 h was significantly related to a higher mortality rate (P=0.021). In a multivariate Cox regression analysis, the Charlson comorbidity index value [adjusted hazard ratio (HR) 1.15, 95% CI 1.02-1.29, P=0.018], sequential organ failure assessment score (adjusted HR 1.23, 95% CI 1.13-1.34, P<0.001), TTP ≤24 h (adjusted HR 2.74, 95% CI 1.51-4.97, P=0.001), timing of appropriate antifungal therapy>72 h (adjusted HR 2.38, 95% CI 1.26-4.51, P=0.008) and persistent candidaemia (adjusted HR 2.50, 95% CI 1.33-4.72, P=0.005) were independently associated with the 6 week mortality rate. Conclusions: A short TTP (≤24 h) for Candida species was independently associated with increased mortality in patients with candidaemia. Additional studies on the relevance of the TTP to clinical outcome in patients with candidaemia are needed.

AB - Objectives: The time to positivity (TTP) of blood cultures is associated with the microbial load in the blood and prognosis in patients with bloodstream infections caused by various bacterial species. However, relevant information about the TTP for Candida species in candidaemia is limited.We investigated the clinical impact of the TTP on mortality in patients with candidaemia. Methods: All consecutive patients=18 years of age with candidaemia between January 2006 and July 2012 were included. The demographics, clinical and microbiological characteristics, antifungal treatment and outcomes of the patients were collected retrospectively. Results: A total of 152 patientswere identified. The overall mortality rate at 6 weekswas 53%. The median TTP for Candida isolates was 27 h (IQR 19-37 h). A TTP of ≤24 h was significantly related to a higher mortality rate (P=0.021). In a multivariate Cox regression analysis, the Charlson comorbidity index value [adjusted hazard ratio (HR) 1.15, 95% CI 1.02-1.29, P=0.018], sequential organ failure assessment score (adjusted HR 1.23, 95% CI 1.13-1.34, P<0.001), TTP ≤24 h (adjusted HR 2.74, 95% CI 1.51-4.97, P=0.001), timing of appropriate antifungal therapy>72 h (adjusted HR 2.38, 95% CI 1.26-4.51, P=0.008) and persistent candidaemia (adjusted HR 2.50, 95% CI 1.33-4.72, P=0.005) were independently associated with the 6 week mortality rate. Conclusions: A short TTP (≤24 h) for Candida species was independently associated with increased mortality in patients with candidaemia. Additional studies on the relevance of the TTP to clinical outcome in patients with candidaemia are needed.

KW - Antifungal therapy

KW - Blood cultures

KW - Bloodstream infections

KW - Outcomes

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