Candida Isolation in Patients Hospitalized on a Surgical Ward: Significance and Mortality-Related Factors

• Published in: World journal of surgery Vol. 33; no. 9; pp. 1822 - 1829
• Main Authors: Marchena-Gomez, J., Saez-Guzman, T., Hemmersbach-Miller, M., Conde-Martel, A., Morales-Leon, V., Bordes-Benitez, A., Acosta-Merida, M. A.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-09-2009; Springer‐Verlag; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Antifungal Drug; Antifungal Therapy; Biological and medical sciences; Candida; Candida - isolation & purification; Candida parapsilosis; Candidiasis - epidemiology; Candidiasis - microbiology; Candidiasis - mortality; Cardiac Surgery; Caspofungin; Chi-Square Distribution; Cross Infection - epidemiology; Cross Infection - microbiology; Cross Infection - mortality; Epidemiology; Female; Fungal Colonization; General aspects; General Surgery; Hospital Mortality; Humans; Incidence; Invasive Fungal Infection; Logistic Models; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Prevalence; Prognosis; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Risk Factors; Surgery; Thoracic Surgery; Vascular Surgery; Antifungal Drug; Fungal Colonization; Antifungal Therapy; Invasive Fungal Infection; Caspofungin; Human; Candidiasis; Mycosis; Mortality; Patient; Hospitalization; Epidemiology; Fungi; Infection; Medicine; Treatment; Candida; Surgery; Isolation; Fungi Imperfecti
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-009-0120-5

Background
Infections caused by
Candida
are an emerging pathology on surgical wards. The aim of the present study was to evaluate the incidence, characteristics, and predictive factors of mortality in patients colonized and/or infected by
Candida
spp. in this setting.
Methods
A consecutive series of 105 patients hospitalized on a general surgery ward between 2000 and 2004 were included, and 118 positive cultures for
Candida
were identified. The variables age, sex, previous medical history, current disease, anemia, ICU stay, type and localization of the microorganism, need for parenteral nutrition, and transfusions were recorded. The primary outcome was in-hospital mortality. A univariate analysis was performed to determine which of these variables were associated with mortality. With a logistic regression model, independent prognostic factors of mortality were determined.
Results
The prevalence of patients colonized and/or infected by
Candida
on our surgical ward was 0.98% (CI 95%: 0.79–1.17), and the incidence was 49 cases per 1,000 patient-years. Of the 105 patients in this series, 56 were men (53%) and 49 women (47%); the mean age was 63.8 years (SD ± 15.7). Twelve patients (11.4%) had candidemia. Crude mortality was 23% (24 patients), whereas the mortality attributable to candidemia was 25% (3/12 cases). Anemia (
p
 = 0.001); transfusions (
p
 = 0.003), and an ICU stay (
p
 = 0.002) were associated with mortality. Candidemia was associated with neoplasms (
p
 = 0.02) and the infection caused by
Candida parapsilosis
(
p
 = 0.04). The only independent factor related to mortality was the anemia (
p
 = 0.028; Odds Ratio: 6.43; 95% CI: 1.23–33.73).
Conclusions
Colonization and/or infection by
Candida
spp. in non-ICU hospitalized surgical patients implies a relative high mortality. Anemia is an independent factor for mortality.