The Prognostic Role of Clinical and Microbiological Factors on Mortality Related to Candida Bloodstream Infections in Hospitalized Patients with Hematologic Malignancies.

Between January 2001 and June 2005 a prospective cohort study of hospitalized patients with hematological malignancies including 47 adults and 30 children with candidemia was conducted at a tertiary oncology care center in Brazil in order to compare the epidemiological characteristics, concurrent illnesses and the clinical microbiological data of both groups that may influence the outcome. The crude mortality was higher in the adult population than in children (46,8% vs. 20,0%) (figure 1). A univariate analysis indicated that in the adult population were lymphoma, neutropenia, presence of comorbidities, a non-removed central venous catheter (CVC), a poor performance status, lack of CVC, use of steroid, hepatic dysfunction, previous surgery, hypotension and severe respiratory dysfunction were risk factors significantly associated with death. Among children the predictors of mortality were acute leukemia, neutropenia, presence of comorbidities, lack of CVC, poor performance status, hypotension, concomitant infected sites, pulmonary infiltrates and severe respiratory dysfunction. Although no major differences was detected in survival rates following fungemia with C. albicans and all Candida non-albicans species, episodes with Candida glabrata, krusei and tropicalis subgroup species had the highest crude death rate compared with C. albicans and other isolates (59,4% vs. 35,3% vs. 10,7%; P<0.01) (figure 2). Candidemia due to C. parapsilosis was associated with the lowest mortality rate. Two variables remained statistically associated with mortality among adults in the multivariate analysis: CVC retention (OR 6.41; 95% CI 1.04–39.55) and presence of comorbidities (OR 2.17; 95% CI 1.33–3.53). Among children only the presence of comorbidities (OR 2.61; 95% CI 1.46–4.66) affected independently the outcome. Our data demonstrate children had a significant lower mortality rate than adults, despite the higher incidence of candidemia in this lower age subjects. There were significant differences of epidemiological, clinical characteristics and other risk factors between both groups. Concurrent comorbidities were the most important independent prognostic factor in both groups of patients.