Antibiotics exposure, risk factors, and outcomes with Candida albicans and non-Candida albicans candidemia. Results from a multi-center study

OBJECTIVE: To define the differences in antibiotics exposure, risk factors, and outcome in hospitalized patients with Candida albicans (C. albicans) and non-C. albicans candidemia.

METHODS: This is a multi-center retrospective study of 132 patients with candidemia from 5 tertiary-care educational hospitals in Shandong, China conducted between January 2009 and June 2010. Fifty-six of 132 (42.4%) patients had candidemia due to C. albicans and 76/132 (57.6%) had non-C. albanians candidemia.

RESULTS: Patients with non-C. albicans candidemia received anti-anaerobic agents more often (23.7% versus 8.9%; p=0.027) and beta-lactam/beta-lactamase inhibitors less often (34.2% versus 51.8%; p=0.043) than those with C. albicans candidemia. Independent risk factors of non-C. albicans candidemia were prior anti-anaerobic and antifungal therapies and central venous catheter placement. Overall, 30-day mortality was higher for patients with C. albicans than non-C. albicans candidemia (50% versus 31.6%; p=0.032). Multivariate logistic regression analysis revealed that C. albicans candidemia, advanced age, and concomitant bacteremia were associated with death due to candidemia.

CONCLUSION: Patients who received anti-anaerobic or antifungal agents were likely to develop non-C. albicans candidemia. Candida albicans infection was associated with poorer prognosis. An awareness of these factors is needed to guide therapy and decrease the high mortality of candidemia.