Mortality in early- and late-onset candidemia

Background. Although candidemia is a well known complication of hospital stay and has a crude mortality of around 40%, few data are available for episodes diagnosed within 10 days after hospital admission. In this paper we compared risk factors for mortality according to the onset of candidemia. Methods. This was a retrospective study of hospitalized patients with early-onset (EOC, <10 days) or late-onset candidemia (LOC, >10 days) to distinctly identify the clinical characteristics and risk factors for 30-day mortality in two Italian Academic Centers. Results. 779 patients were included in the study: 183 EOC and 596 LOC. Mortality was significantly lower in EOC (71/183, 38.8% versus 283/596, 51.1%, P = 0.03). In EOC, multivariate analysis showed that inadequate initial antifungal therapy (IIAT) (P = 0.005, Odds Ratio [OR] 3.02, 95% Confidence Interval [CI], 1.40-6.51), C. albicans etiology (P = 0.02, OR 2.17, 95% CI, 1.11-4.26) and older age (P < 0.001, OR 1.05, 95% CI, 1.02-1.07) were independent risk factors for mortality. In LOC, liver disease (P = 0.003, OR 2.46, 95% CI, 1.36-4.43), IIAT (p = 0.002, OR 2.01, 95% CI, 1.28-3.15) and older age (P < 0.001, OR 1.03, 95% CI, 1.02-1.04) were independently associated with a fatal outcome, while treatment with caspofungin was associated with survival (P < 0.001, OR 0.42, 95% CI, 0.26-0.67). Conclusions. EOC has different clinical characteristics and risk factors for mortality compared to LOC. Although EOC mortality is significantly lower, the rate of inappropriate antifungal treatment is higher. Treatment with caspofungin is significantly associated with survival in patients with LOC. Efforts are needed to improve diagnosis and treatment of EOC.