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Risk factors for breakthrough candidemia.

M Nucci1, A L Colombo

  • 1University Hospital, Universidade Federal do Rio de Janeiro, Avenida Brigadeiro Trompovsky, s/n 21941-590, Rio de Janeiro, Brazil. mnucci@hucff.ufrj.br

European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology
|April 17, 2002
PubMed
Summary

Profound neutropenia, corticosteroid use, and heavy antibiotic exposure are key risk factors for breakthrough candidemia. Gastrointestinal colonization appears to be a significant factor in its development.

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Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Epidemiology

Background:

  • Breakthrough candidemia, fungal bloodstream infections occurring despite antifungal therapy, poses a significant clinical challenge.
  • Identifying risk factors is crucial for preventing and managing invasive fungal infections.

Purpose of the Study:

  • To identify independent risk factors for breakthrough candidemia in hospitalized patients.
  • To elucidate the role of gastrointestinal colonization in the pathogenesis of breakthrough candidemia.

Main Methods:

  • Retrospective analysis of 270 candidemia cases from two tertiary hospitals.
  • Multivariate logistic regression analysis to determine significant risk factors.

Main Results:

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  • Profound neutropenia (OR, 9.14), corticosteroid use (OR, 3.17), and heavy antibiotic exposure (OR, 2.93) were identified as independent risk factors.
  • Neither isolate susceptibility nor catheter presence was a significant risk factor.
  • Gastrointestinal colonization is implicated as a major contributor.

Conclusions:

  • Profound neutropenia, corticosteroid use, and broad-spectrum antibiotic exposure are critical risk factors for breakthrough candidemia.
  • Preventive strategies should consider these factors and the role of gut microbiome.
  • Further research into gastrointestinal colonization as a source is warranted.