Disclosures: Mazi and Spec report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
January 23, 2022
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Attributable death from Candida bloodstream infection remains high

Disclosures: Mazi and Spec report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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The 90-day crude mortality among more than 600 patients with Candida bloodstream infections at a St. Louis hospital was higher than 40%, a study found.

The attributable risk difference for 90-day mortality among these patients was twice as high compared with matched controls, researchers reported.

“People often suggest that people die ‘with Candida, not from Candida because of the underlying issues that lead to acquiring the Candida. That is simply not true,” Andrej Spec, MD, MSCI, an assistant professor of infectious diseases and associate director of the Infectious Disease Clinical Research Unit at Washington University in St. Louis School of Medicine, told Healio.

Andrej Spec

“It is an incredibly serious disease that carries a very high mortality and much of that mortality is preventable if patients are managed well,” Spec said.

Spec and colleagues conducted a retrospective cohort study of adult patients admitted to Barnes Jewish Hospital from Jan. 2, 2012, through April 30, 2019. According to the study, they identified 626 adult patients with Candida bloodstream infections (BSI) and frequency-matched them with 6,269 controls with similar Candida BSI risk factors.

They calculated 90-day all-cause mortality attributable to Candida BSI using three methods — propensity score matching, matching by inverse weighting of propensity score, and stratified analysis by quintile.

The study demonstrated that the 90-day crude mortality was 42.4% for Candida BSI cases and 17.1% for frequency-matched controls. The researchers calculated the attributable risk difference for 90-day mortality as 28.4% (HR = 2.12; 95% CI, 1.98-2.25).

Additionally, their analysis revealed that the risk for mortality at 90 days was highest among patients in the lowest risk quintile to develop Candida BSI (HR = 3.13; 95% CI, 2.33-4.19). These patients accounted for 61% of the 130 untreated patients with Candida BSI, Spec and colleagues said.

“One thing that I think is unique about our study was that we analyzed our data in three different ways and came up with nearly identical results using each method,” Patrick B. Mazi, MD, a third-year infectious diseases fellow at Washington University in St. Louis, told Healio. “That gave us a lot of confidence in cumulative result and our interpretation of its meaning.”

Spec said the results prove that Candida is a very serious infection that requires complex and coordinated care to ensure optimal outcomes.

“It should be prevented as much as we are able to, but when it does happen, it must be aggressively managed,” he said.