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INFECTIOUS DISEASES

Epidemiology, Risk Factors, and Outcomes of Candida albicans Versus Non-albicans Candidemia in Nonneutropenic Patients

Clinical Assistant Professor of Pharmacy Practice, Wayne State University; Clinical Specialist, Henry Ford Hospital, Detroit, MI

Jose A Vazquez, MD FACP FIDSA

Professor of Medicine, Wayne State University; Infectious Diseases Consulting Staff, Henry Ford Hospital

Peggy S McKinnon, PharmD

Clinical Pharmacist in Clinical Research and Infectious Diseases, Barnes-Jewish Hospital, St. Louis, MO

Reprints: Dr. McKinnon, Barnes-Jewish Hospital, Mailstop 90-52-411, 216 S. Kingshighway, St. Louis, MO 63110, fax 314/362-6402, psm9154{at}bjc.org

BACKGROUND: Candidemia is a major cause of morbidity and mortality in hospitalized patients.

OBJECTIVES: To describe the epidemiology of and risk factors for non-albicans candidemia (NAC) in nonneutropenic adults and the impact of NAC on patient outcomes and treatment cost.

METHODS: We conducted a retrospective cohort analysis comparing demographics and risk factors for Candida albicans candidemia (CAC) versus NAC in 144 nonneutropenic patients with candidemia over a 6 year period (1997–2002) at Detroit Receiving Hospital.

RESULTS: Candida species distribution included albicans (50%), parapsilosis (13%), tropicalis (10%), and glabrata (13%). Predominant species varied by patient care unit, with C. glabrata more common in the medical intensive care unit (ICU) and C. parapsilosis in the burn ICU. In multivariate analysis, NAC was associated with the absence of antibiotic use at the onset of candidemia, recent history of solid tumor, and male sex. NAC was not associated with an increase in mortality or length of stay compared with CAC, but was found to have a higher cost of antifungal therapy ($2030 vs $780; p = 0.05).

CONCLUSIONS: The epidemiology of candidemia is complex and varies among the different patient care units. Specifically, patients appear less likely to develop NAC if they are receiving antibiotics at the onset of candidemia. Increased awareness of risk factors for NAC can be used to guide adequate initial antifungal therapy.

Key Words: Candida albicans, non-albicans

Published Online, March 20, 2007. www.theannals.com, DOI 10.1345/aph.1H516

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Could Risk Assessment for Non-albicans Candida Improve Empiric Treatment for Invasive Candidiasis?

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				D. Trofa, A. Gacser, and J. D. Nosanchuk Candida parapsilosis, an Emerging Fungal Pathogen Clin. Microbiol. Rev., October 1, 2008; 21(4): 606 - 625. [Abstract] [Full Text] [PDF]

				D. M Vandijck, S. I Blot, and J. M Decruyenaere Comment: Epidemiology, Risk Factors, and Outcomes of Candida albicans Versus Non-albicans Candidemia in Nonneutropenic Patients Ann. Pharmacother., November 1, 2007; 41(11): 1916 - 1917. [Full Text] [PDF]

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