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Risk factors for hospital-acquired candidemia. A matched case-control study
1Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City.
Abstract:
Nosocomial candidemia has become an important infection not only because of an apparently increasing incidence but also because of its high fatality rate. We studied 28 risk factors through a matched case-control study that included 88 pairs of patients hospitalized between July 1983 and December 1986. The strongest single risk factor found in the univariate analysis was the number of prior antibiotics administered: the exposure odds ratio (OR) was 12.50 when patients who received three to five antibiotics were compared with those who received none to two antibiotics. A multiple logistic regression analysis using a conditional likelihood method was performed to evaluate several risk factors simultaneously. The final model selected by a stepwise procedure included the following variables: number of antibiotics received prior to infection (OR, 1.73 per unit increase), isolation of Candida species from sites other than blood (OR, 10.37), prior hemodialysis (OR, 18.13), and prior use of a Hickman catheter (OR, 7.23). It remains to be shown in controlled clinical trials whether limiting the number of antibiotics or instituting prophylaxis and/or early treatment for high-risk patients will reduce the incidence of nosocomial candidemia.
Insights
Nosocomial candidemia, a serious hospital infection, is linked to prior antibiotic use, hemodialysis, and central venous catheters. Identifying these risk factors is key to reducing candidemia incidence.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Clinical Microbiology
Background:
- Nosocomial candidemia presents a significant clinical challenge due to increasing incidence and high mortality.
- Understanding the risk factors associated with these infections is crucial for effective prevention strategies.
Purpose of the Study:
- To identify and quantify risk factors associated with the development of nosocomial candidemia.
- To inform potential interventions for reducing the burden of hospital-acquired fungal infections.
Main Methods:
- A matched case-control study design was employed.
- Eighty-eight pairs of patients hospitalized between July 1983 and December 1986 were analyzed.
- Univariate and multiple logistic regression analyses were used to assess 28 potential risk factors.
Main Results:
- Prior administration of antibiotics was a significant risk factor (Odds Ratio [OR] = 12.50 for 3-5 vs. 0-2 antibiotics).
- Multivariable analysis identified number of prior antibiotics (OR, 1.73 per unit increase), non-blood Candida isolation (OR, 10.37), prior hemodialysis (OR, 18.13), and prior Hickman catheter use (OR, 7.23) as independent predictors.
- These findings highlight key patient characteristics and exposures associated with increased risk.
Conclusions:
- The study identified several significant risk factors for nosocomial candidemia, including antibiotic exposure and invasive devices.
- Further controlled clinical trials are warranted to evaluate interventions such as limiting antibiotic use or implementing prophylaxis for high-risk patients.