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Intensive Care Medicine
Published in: Intensive Care Medicine 4/2017

01-04-2017 | Original

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

Authors: 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 G. De Rosa, Leonel Lagunes, Jordi Rello, George Dimopoulos, Arnaldo L. Colombo, Marcio Nucci, Antonio Vena, Emilio Bouza, Patricia Muñoz, Mario Tumbarello, Raffaella Losito, Ignacio Martin-Loeches, Claudio Viscoli

Published in: Intensive Care Medicine | Issue 4/2017

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.
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Metadata
Title
Clinical characteristics and predictors of mortality in cirrhotic patients with candidemia and intra-abdominal candidiasis: a multicenter study
Authors
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 G. De Rosa
Leonel Lagunes
Jordi Rello
George Dimopoulos
Arnaldo L. Colombo
Marcio Nucci
Antonio Vena
Emilio Bouza
Patricia Muñoz
Mario Tumbarello
Raffaella Losito
Ignacio Martin-Loeches
Claudio Viscoli
Publication date
01-04-2017
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 4/2017
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-017-4717-0

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