Background: Candida spp. are the fifth most common cause of bloodstream infections in our institution. The aim of this study was to evaluate antifungal therapy and mortality in patients with candidemia and septic shock. Methods: All patients with bloodstream infections due to Candida were identified by review of microbiology data from 2003 through 2005. Charts were reviewed to identify patients with severe sepsis and refractory hypotension. Patient demographics, severity of illness (APACHE II), risk factors for candidemia, antibiotic therapy, species of Candida, and mortality were collected. Results: 23 of 113 (20%) patients with candidemia developed septic shock; 11 (48%) died. Risk factors associated with death included malignancy, neutropenia, and prior antibacterial therapy ( p = 0.04, p = 0.05, and p = 0.08, respectively, onetailed Fisher’s exact test). No difference in APACHE II scores was observed between survivors and non-survivors ( p = 0.22). 13 of 23 (57%) episodes were due to non-albicans species (6 C. glabrata, 2 C. krusei). Delay in initiating antifungal therapy was common. Only 3 patients received antifungal therapy prior to positive blood cultures. Conclusion: Septic shock due to candidemia was associated with significant mortality. Delays in antifungal therapy were common. The empiric addition of antifungal therapy for patients with septic shock may be considered in those at risk for candidemia.
Full conference title:
Infectious Diseases Society of America, 44th Annual Meeting
- IDSA 44th