Clinical and microbiological factors associated with mortality in candidemia in adult patients 2007-2016

Background: Candidemia is a life-threatening infection with high mortality. Our aim was to evaluate the Candida species distribution, antifungal susceptibilities and risk factors associated with 30-day mortality in candidemia in Southern Finland. Methods: We present a retrospective analysis of candidemia cases from the hospital district of Helsinki and Uusimaa during 2007-2016. Patients younger than 18 years old were excluded. A total of 386 candida isolates from 374 episodes of candidemia were identified in 350 adult patients. Results: Candida albicans was the leading cause of candidemia (60.4%), followed by C. glabrata (21.5%), C. parapsilosis (5.2%) and C. dubliniensis (5.2%). There was no statistically significant change in the distribution of C. albicans vs non-albicans species during the study period. Thirty-day overall mortality was 30.7%. When patients who received no antifungal treatment were excluded from the mortality analysis, 30-day mortality was 23.0%. Severity of underlying illnesses (OR 20.55, 95% CI 5.98-70.60), ICU stay at the onset of candidemia (OR 5.06, 95% CI 1.75-14.68) and age >65 years (OR 3.98, 95% CI 1.97-8.02) were independent risk factors of 30-day mortality in multivariable analysis. However, there was no statistically significant association between 30-day mortality and an early start of an effective antifungal. Conclusion: There was not a significant shift to non-albicans species as the cause of candidemia in Southern Finland during the 10-year study period. Furthermore, we did not find an association between 30-day mortality and the early start of an antifungal treatment. Comorbidity considerably increased the risk of fatal outcome.