Epidemiology and predictive factors for early and late mortality in Candida bloodstream infections: A population-based surveillance in Spain

M. Puig-Asensio; B. Padilla; J. Garnacho-Montero; O. Zaragoza; J. M. Aguado; R. Zaragoza; M. Montejo; P. Muñoz; I. Ruiz-Camps; M. Cuenca-Estrella; B. Almirante; Jesús Guinea; José Ramón Pãno; Julio García; Carlos García; Jesús Fortún; Pilar Martín; Elia Gómez; Pablo Ryan; Carolina Campelo; Ignacio de los Santos; Buenaventura Buendía; Beatriz Perez; Mercedes Alonso; Francisca Sanz; Paloma Merino; Fernando González; Miguel Gorgolas; Ignacio Gadea; Juan Emilio Losa; Alberto Delgado-Iribarren; Antonio Ramos; Yolanda Romero; Isabel Sánchez; Jeśus Rodriguez-Bãno; Ana Isabel Suarez; Ana Loza; Estrella Martín-Mazuelos; Ana Isabel Aller; Maite Ruiz; Carlos Ortiz; Mónica Chávez; Fernando L. Maroto; Miguel Salavert; Javier Pemán; José Blanquer; David Navarro; Vicente Abril; Concepción Gimeno; Juan José Camarena; Silvia Hernáez; Guillermo Ezpeleta; Elena Bereciartua; José L. Hernández; Rosa Ana Rivas; Rafael Ayarza; Ana Ma Planes; José Mensa; Manel Almela; Mercé Gurgui; Ferran Sánchez-Reus; Joaquin Martinez-Montauti; Montserrat Sierra; Juan Pablo Horcajada; Luisa Sorli; Juliá Gómez; Amadeu Gené; Mireia Urrea; Maricela Valerio; Mario Fernández-Ruiz; Ana Díaz-Martín; Francesc Puchades; Alessandra Mularoni

doi:10.1111/1469-0691.12380

Epidemiology and predictive factors for early and late mortality in Candida bloodstream infections: A population-based surveillance in Spain

M. Puig-Asensio, B. Padilla, J. Garnacho-Montero, O. Zaragoza, J. M. Aguado, R. Zaragoza, M. Montejo, P. Muñoz, I. Ruiz-Camps, M. Cuenca-Estrella, B. Almirante, Jesús Guinea, José Ramón Pãno, Julio García, Carlos García, Jesús Fortún, Pilar Martín, Elia Gómez, Pablo Ryan, Carolina CampeloIgnacio de los Santos, Buenaventura Buendía, Beatriz Perez, Mercedes Alonso, Francisca Sanz, Paloma Merino, Fernando González, Miguel Gorgolas, Ignacio Gadea, Juan Emilio Losa, Alberto Delgado-Iribarren, Antonio Ramos, Yolanda Romero, Isabel Sánchez, Jeśus Rodriguez-Bãno, Ana Isabel Suarez, Ana Loza, Estrella Martín-Mazuelos, Ana Isabel Aller, Maite Ruiz, Carlos Ortiz, Mónica Chávez, Fernando L. Maroto, Miguel Salavert, Javier Pemán, José Blanquer, David Navarro, Vicente Abril, Concepción Gimeno, Juan José Camarena, Silvia Hernáez, Guillermo Ezpeleta, Elena Bereciartua, José L. Hernández, Rosa Ana Rivas, Rafael Ayarza, Ana Ma Planes, José Mensa, Manel Almela, Mercé Gurgui, Ferran Sánchez-Reus, Joaquin Martinez-Montauti, Montserrat Sierra, Juan Pablo Horcajada, Luisa Sorli, Juliá Gómez, Amadeu Gené, Mireia Urrea, Maricela Valerio, Mario Fernández-Ruiz, Ana Díaz-Martín, Francesc Puchades, Alessandra Mularoni

Research output: Contribution to journal › Article › Research › peer-review

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Abstract

A prospective, multicentre, population-based surveillance programme for Candida bloodstream infections was implemented in five metropolitan areas of Spain to determine its incidence and the prevalence of antifungal resistance, and to identify predictors of death. Between May 2010 and April 2011, Candida isolates were centralized to a reference laboratory for species identification by DNA sequencing and for susceptibility testing by EUCAST reference procedure. Prognostic factors associated with early (0-7 days) and late (8-30 days) death were analysed using logistic regression modelling. We detected 773 episodes: annual incidence of 8.1 cases/100 000 inhabitants, 0.89/1000 admissions and 1.36/10 000 patient-days. Highest incidence was found in infants younger than 1 year (96.4/100 000 inhabitants). Candida albicans was the predominant species (45.4%), followed by Candida parapsilosis (24.9%), Candida glabrata (13.4%) and Candida tropicalis (7.7%). Overall, 79% of Candida isolates were susceptible to fluconazole. Cumulative mortality at 7 and 30 days after the first episode of candidaemia was 12.8% and 30.6%, respectively. Multivariate analysis showed that therapeutic measures within the first 48 h may improve early mortality: antifungal treatment (OR 0.51, 95% CI 0.27-0.95) and central venous catheter removal (OR 0.43, 95% CI 0.21-0.87). Predictors of late death included host factors (e.g. patients' comorbid status and signs of organ dysfunction), primary source (OR 1.63, 95% CI 1.03-2.61), and severe sepsis or septic shock (OR 1.77, 95% CI 1.05-3.00). In Spain, the proportion of Candida isolates non-susceptible to fluconazole is higher than in previous reports. Early mortality may be improved with strict adherence to guidelines. © 2013 European Society of Clinical Microbiology and Infectious Diseases.

Original language	English
Journal	Clinical Microbiology and Infection
Volume	20
Issue number	4
DOIs	https://doi.org/10.1111/1469-0691.12380
Publication status	Published - 1 Jan 2014

Keywords

Antifungal resistance
Candida bloodstream infections
Early mortality
Epidemiology
Prognostic factors
Surveillance

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/1469-0691.12380

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Puig-Asensio, M., Padilla, B., Garnacho-Montero, J., Zaragoza, O., Aguado, J. M., Zaragoza, R., Montejo, M., Muñoz, P., Ruiz-Camps, I., Cuenca-Estrella, M., Almirante, B., Guinea, J., Pãno, J. R., García, J., García, C., Fortún, J., Martín, P., Gómez, E., Ryan, P., ... Mularoni, A. (2014). Epidemiology and predictive factors for early and late mortality in Candida bloodstream infections: A population-based surveillance in Spain. Clinical Microbiology and Infection, 20(4). https://doi.org/10.1111/1469-0691.12380

@article{b2a4d03c345947e282efb50606cedae7,

title = "Epidemiology and predictive factors for early and late mortality in Candida bloodstream infections: A population-based surveillance in Spain",

abstract = "A prospective, multicentre, population-based surveillance programme for Candida bloodstream infections was implemented in five metropolitan areas of Spain to determine its incidence and the prevalence of antifungal resistance, and to identify predictors of death. Between May 2010 and April 2011, Candida isolates were centralized to a reference laboratory for species identification by DNA sequencing and for susceptibility testing by EUCAST reference procedure. Prognostic factors associated with early (0-7 days) and late (8-30 days) death were analysed using logistic regression modelling. We detected 773 episodes: annual incidence of 8.1 cases/100 000 inhabitants, 0.89/1000 admissions and 1.36/10 000 patient-days. Highest incidence was found in infants younger than 1 year (96.4/100 000 inhabitants). Candida albicans was the predominant species (45.4%), followed by Candida parapsilosis (24.9%), Candida glabrata (13.4%) and Candida tropicalis (7.7%). Overall, 79% of Candida isolates were susceptible to fluconazole. Cumulative mortality at 7 and 30 days after the first episode of candidaemia was 12.8% and 30.6%, respectively. Multivariate analysis showed that therapeutic measures within the first 48 h may improve early mortality: antifungal treatment (OR 0.51, 95% CI 0.27-0.95) and central venous catheter removal (OR 0.43, 95% CI 0.21-0.87). Predictors of late death included host factors (e.g. patients' comorbid status and signs of organ dysfunction), primary source (OR 1.63, 95% CI 1.03-2.61), and severe sepsis or septic shock (OR 1.77, 95% CI 1.05-3.00). In Spain, the proportion of Candida isolates non-susceptible to fluconazole is higher than in previous reports. Early mortality may be improved with strict adherence to guidelines. {\textcopyright} 2013 European Society of Clinical Microbiology and Infectious Diseases.",

keywords = "Antifungal resistance, Candida bloodstream infections, Early mortality, Epidemiology, Prognostic factors, Surveillance",

author = "M. Puig-Asensio and B. Padilla and J. Garnacho-Montero and O. Zaragoza and Aguado, {J. M.} and R. Zaragoza and M. Montejo and P. Mu{\~n}oz and I. Ruiz-Camps and M. Cuenca-Estrella and B. Almirante and Jes{\'u}s Guinea and P{\~a}no, {Jos{\'e} Ram{\'o}n} and Julio Garc{\'i}a and Carlos Garc{\'i}a and Jes{\'u}s Fort{\'u}n and Pilar Mart{\'i}n and Elia G{\'o}mez and Pablo Ryan and Carolina Campelo and {de los Santos}, Ignacio and Buenaventura Buend{\'i}a and Beatriz Perez and Mercedes Alonso and Francisca Sanz and Paloma Merino and Fernando Gonz{\'a}lez and Miguel Gorgolas and Ignacio Gadea and Losa, {Juan Emilio} and Alberto Delgado-Iribarren and Antonio Ramos and Yolanda Romero and Isabel S{\'a}nchez and Je{\'s}us Rodriguez-B{\~a}no and Suarez, {Ana Isabel} and Ana Loza and Estrella Mart{\'i}n-Mazuelos and Aller, {Ana Isabel} and Maite Ruiz and Carlos Ortiz and M{\'o}nica Ch{\'a}vez and Maroto, {Fernando L.} and Miguel Salavert and Javier Pem{\'a}n and Jos{\'e} Blanquer and David Navarro and Vicente Abril and Concepci{\'o}n Gimeno and Camarena, {Juan Jos{\'e}} and Silvia Hern{\'a}ez and Guillermo Ezpeleta and Elena Bereciartua and Hern{\'a}ndez, {Jos{\'e} L.} and Rivas, {Rosa Ana} and Rafael Ayarza and Planes, {Ana Ma} and Jos{\'e} Mensa and Manel Almela and Merc{\'e} Gurgui and Ferran S{\'a}nchez-Reus and Joaquin Martinez-Montauti and Montserrat Sierra and Horcajada, {Juan Pablo} and Luisa Sorli and Juli{\'a} G{\'o}mez and Amadeu Gen{\'e} and Mireia Urrea and Maricela Valerio and Mario Fern{\'a}ndez-Ruiz and Ana D{\'i}az-Mart{\'i}n and Francesc Puchades and Alessandra Mularoni",

year = "2014",

month = jan,

day = "1",

doi = "10.1111/1469-0691.12380",

language = "English",

volume = "20",

journal = "Clinical Microbiology and Infection",

issn = "1198-743X",

publisher = "Elsevier Limited",

number = "4",

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Puig-Asensio, M, Padilla, B, Garnacho-Montero, J, Zaragoza, O, Aguado, JM, Zaragoza, R, Montejo, M, Muñoz, P, Ruiz-Camps, I, Cuenca-Estrella, M, Almirante, B, Guinea, J, Pãno, JR, García, J, García, C, Fortún, J, Martín, P, Gómez, E, Ryan, P, Campelo, C, de los Santos, I, Buendía, B, Perez, B, Alonso, M, Sanz, F, Merino, P, González, F, Gorgolas, M, Gadea, I, Losa, JE, Delgado-Iribarren, A, Ramos, A, Romero, Y, Sánchez, I, Rodriguez-Bãno, J, Suarez, AI, Loza, A, Martín-Mazuelos, E, Aller, AI, Ruiz, M, Ortiz, C, Chávez, M, Maroto, FL, Salavert, M, Pemán, J, Blanquer, J, Navarro, D, Abril, V, Gimeno, C, Camarena, JJ, Hernáez, S, Ezpeleta, G, Bereciartua, E, Hernández, JL, Rivas, RA, Ayarza, R, Planes, AM, Mensa, J, Almela, M, Gurgui, M, Sánchez-Reus, F, Martinez-Montauti, J, Sierra, M, Horcajada, JP, Sorli, L, Gómez, J, Gené, A, Urrea, M, Valerio, M, Fernández-Ruiz, M, Díaz-Martín, A, Puchades, F & Mularoni, A 2014, 'Epidemiology and predictive factors for early and late mortality in Candida bloodstream infections: A population-based surveillance in Spain', Clinical Microbiology and Infection, vol. 20, no. 4. https://doi.org/10.1111/1469-0691.12380

TY - JOUR

T1 - Epidemiology and predictive factors for early and late mortality in Candida bloodstream infections: A population-based surveillance in Spain

AU - Puig-Asensio, M.

AU - Padilla, B.

AU - Garnacho-Montero, J.

AU - Zaragoza, O.

AU - Aguado, J. M.

AU - Zaragoza, R.

AU - Montejo, M.

AU - Muñoz, P.

AU - Ruiz-Camps, I.

AU - Cuenca-Estrella, M.

AU - Almirante, B.

AU - Guinea, Jesús

AU - Pãno, José Ramón

AU - García, Julio

AU - García, Carlos

AU - Fortún, Jesús

AU - Martín, Pilar

AU - Gómez, Elia

AU - Ryan, Pablo

AU - Campelo, Carolina

AU - de los Santos, Ignacio

AU - Buendía, Buenaventura

AU - Perez, Beatriz

AU - Alonso, Mercedes

AU - Sanz, Francisca

AU - Merino, Paloma

AU - González, Fernando

AU - Gorgolas, Miguel

AU - Gadea, Ignacio

AU - Losa, Juan Emilio

AU - Delgado-Iribarren, Alberto

AU - Ramos, Antonio

AU - Romero, Yolanda

AU - Sánchez, Isabel

AU - Rodriguez-Bãno, Jeśus

AU - Suarez, Ana Isabel

AU - Loza, Ana

AU - Martín-Mazuelos, Estrella

AU - Aller, Ana Isabel

AU - Ruiz, Maite

AU - Ortiz, Carlos

AU - Chávez, Mónica

AU - Maroto, Fernando L.

AU - Salavert, Miguel

AU - Pemán, Javier

AU - Blanquer, José

AU - Navarro, David

AU - Abril, Vicente

AU - Gimeno, Concepción

AU - Camarena, Juan José

AU - Hernáez, Silvia

AU - Ezpeleta, Guillermo

AU - Bereciartua, Elena

AU - Hernández, José L.

AU - Rivas, Rosa Ana

AU - Ayarza, Rafael

AU - Planes, Ana Ma

AU - Mensa, José

AU - Almela, Manel

AU - Gurgui, Mercé

AU - Sánchez-Reus, Ferran

AU - Martinez-Montauti, Joaquin

AU - Sierra, Montserrat

AU - Horcajada, Juan Pablo

AU - Sorli, Luisa

AU - Gómez, Juliá

AU - Gené, Amadeu

AU - Urrea, Mireia

AU - Valerio, Maricela

AU - Fernández-Ruiz, Mario

AU - Díaz-Martín, Ana

AU - Puchades, Francesc

AU - Mularoni, Alessandra

PY - 2014/1/1

Y1 - 2014/1/1

N2 - A prospective, multicentre, population-based surveillance programme for Candida bloodstream infections was implemented in five metropolitan areas of Spain to determine its incidence and the prevalence of antifungal resistance, and to identify predictors of death. Between May 2010 and April 2011, Candida isolates were centralized to a reference laboratory for species identification by DNA sequencing and for susceptibility testing by EUCAST reference procedure. Prognostic factors associated with early (0-7 days) and late (8-30 days) death were analysed using logistic regression modelling. We detected 773 episodes: annual incidence of 8.1 cases/100 000 inhabitants, 0.89/1000 admissions and 1.36/10 000 patient-days. Highest incidence was found in infants younger than 1 year (96.4/100 000 inhabitants). Candida albicans was the predominant species (45.4%), followed by Candida parapsilosis (24.9%), Candida glabrata (13.4%) and Candida tropicalis (7.7%). Overall, 79% of Candida isolates were susceptible to fluconazole. Cumulative mortality at 7 and 30 days after the first episode of candidaemia was 12.8% and 30.6%, respectively. Multivariate analysis showed that therapeutic measures within the first 48 h may improve early mortality: antifungal treatment (OR 0.51, 95% CI 0.27-0.95) and central venous catheter removal (OR 0.43, 95% CI 0.21-0.87). Predictors of late death included host factors (e.g. patients' comorbid status and signs of organ dysfunction), primary source (OR 1.63, 95% CI 1.03-2.61), and severe sepsis or septic shock (OR 1.77, 95% CI 1.05-3.00). In Spain, the proportion of Candida isolates non-susceptible to fluconazole is higher than in previous reports. Early mortality may be improved with strict adherence to guidelines. © 2013 European Society of Clinical Microbiology and Infectious Diseases.

AB - A prospective, multicentre, population-based surveillance programme for Candida bloodstream infections was implemented in five metropolitan areas of Spain to determine its incidence and the prevalence of antifungal resistance, and to identify predictors of death. Between May 2010 and April 2011, Candida isolates were centralized to a reference laboratory for species identification by DNA sequencing and for susceptibility testing by EUCAST reference procedure. Prognostic factors associated with early (0-7 days) and late (8-30 days) death were analysed using logistic regression modelling. We detected 773 episodes: annual incidence of 8.1 cases/100 000 inhabitants, 0.89/1000 admissions and 1.36/10 000 patient-days. Highest incidence was found in infants younger than 1 year (96.4/100 000 inhabitants). Candida albicans was the predominant species (45.4%), followed by Candida parapsilosis (24.9%), Candida glabrata (13.4%) and Candida tropicalis (7.7%). Overall, 79% of Candida isolates were susceptible to fluconazole. Cumulative mortality at 7 and 30 days after the first episode of candidaemia was 12.8% and 30.6%, respectively. Multivariate analysis showed that therapeutic measures within the first 48 h may improve early mortality: antifungal treatment (OR 0.51, 95% CI 0.27-0.95) and central venous catheter removal (OR 0.43, 95% CI 0.21-0.87). Predictors of late death included host factors (e.g. patients' comorbid status and signs of organ dysfunction), primary source (OR 1.63, 95% CI 1.03-2.61), and severe sepsis or septic shock (OR 1.77, 95% CI 1.05-3.00). In Spain, the proportion of Candida isolates non-susceptible to fluconazole is higher than in previous reports. Early mortality may be improved with strict adherence to guidelines. © 2013 European Society of Clinical Microbiology and Infectious Diseases.

KW - Antifungal resistance

KW - Candida bloodstream infections

KW - Early mortality

KW - Epidemiology

KW - Prognostic factors

KW - Surveillance

U2 - 10.1111/1469-0691.12380

DO - 10.1111/1469-0691.12380

M3 - Article

VL - 20

JO - Clinical Microbiology and Infection

JF - Clinical Microbiology and Infection

SN - 1198-743X

IS - 4

ER -

Epidemiology and predictive factors for early and late mortality in Candida bloodstream infections: A population-based surveillance in Spain

Abstract

Keywords

UN SDGs

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