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30-day mortality in invasive candidiasis and candidemia in a multidisciplinary hospital in Moscow, Russia
Sergey S Andreev1, Polina O Narusova1, Anton A Chernov1
1Clinical City Hospital No. 52, Ministry of Healthcare of Moscow, Moscow, Russia.
Background And Purpose:
One of the most severe mycotic infections caused by Candida spp. is invasive candidiasis. According to the literature, among all healthcare- associated infections, it has the highest mortality rate. This study aimed to assess 30-day and overall mortality in invasive candidiasis and candidemia patients depending on the antifungal therapy (AFT) regimens.
Materials And Methods:
This single-center retrospective study of 30-day survival was conducted at Clinical City Hospital No. 52, Moscow Healthcare Department in Moscow, Russia. The participants were 169 patients aged 19-94 years who had verified invasive candidiasis with candidemia during hospitalization in 2020-2023. This study included patients with Candida spp. isolated from blood culture using matrix-assisted laser desorption/ionization with time-of-flight mass spectrometry, and proven invasive candidiasis according to EORTC/MSG criteria. Patient survival analysis was performed using the Kaplan-Meier method, which is a nonparametric approach for estimating time- to-event. Risk of death was compared between the group of patients receiving AFT after pathogen verification and the group of patients receiving AFT before and after blood culture results.
Results:
Based on the findings, the likelihood of death was lower in the group of patients who received AFT both after and before blood culture results compared to the group of patients who received it after verification of the diagnosis. By day 50 of hospitalization, the risks of death were comparable between the two groups. However, when analyzing the overall mortality, the odds of death in patients with AFT before and after receiving blood culture results were 2.56 times higher (OR=0.391; 95% CI: 0.177-0.865; p=0.019) compared with patients to whom antifungal therapy was prescribed only after blood culture results.
Conclusion:
This study provided the first data regarding the assessment of 30-day mortality and risk factors for death. Risk of 30-day mortality was lower in the group of patients receiving AFT both before and after the blood culture, but overall mortality in this group was higher, compared to patients who received AFT after the blood culture.
Insights
Invasive candidiasis patients receiving antifungal therapy (AFT) before and after blood culture results had lower 30-day mortality but higher overall mortality. This highlights the complex impact of AFT timing on patient survival outcomes.
Area of Science:
- Infectious Diseases
- Medical Mycology
- Clinical Research
Background:
- Invasive candidiasis, a severe fungal infection caused by Candida spp., has a high mortality rate among healthcare-associated infections.
- Antifungal therapy (AFT) timing is a critical factor in managing invasive candidiasis and candidemia.
Purpose of the Study:
- To assess 30-day and overall mortality in patients with invasive candidiasis and candidemia.
- To evaluate the impact of different antifungal therapy (AFT) regimens on patient survival.
Main Methods:
- A single-center retrospective study involving 169 patients hospitalized with invasive candidiasis and candidemia between 2020-2023.
- Identification of Candida spp. using MALDI-TOF MS and diagnosis confirmation based on EORTC/MSG criteria.
- Survival analysis using the Kaplan-Meier method to compare mortality risks between patients receiving AFT before/after blood culture results versus after verification.
Main Results:
- Patients receiving AFT both before and after blood culture results showed a lower risk of 30-day mortality compared to those receiving AFT after diagnosis verification.
- By day 50, mortality risks were comparable between the two groups.
- However, overall mortality was significantly higher (OR=0.391; 95% CI: 0.177-0.865; p=0.019) in patients who received AFT before and after blood culture results.
Conclusions:
- This study provides novel insights into 30-day mortality and risk factors in invasive candidiasis.
- While AFT initiated before blood culture results may reduce short-term mortality, it is associated with increased overall mortality.
- The timing of antifungal therapy significantly influences survival outcomes in invasive candidiasis patients.
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