Κey Role of Early Source Control in Candidemic Patients With Sepsis or Septic Shock.
antifungal treatment
catheter removal
sepsis
septic shock
source control
Journal
Open forum infectious diseases
ISSN: 2328-8957
Titre abrégé: Open Forum Infect Dis
Pays: United States
ID NLM: 101637045
Informations de publication
Date de publication:
Aug 2022
Aug 2022
Historique:
received:
01
06
2022
accepted:
29
07
2022
entrez:
12
8
2022
pubmed:
13
8
2022
medline:
13
8
2022
Statut:
epublish
Résumé
Despite advances in diagnostic and therapeutic approaches, candidemia remains associated with high mortality rates. This study aimed at identifying predictors of mortality among patients with candidemia, with a focus on early interventions that can improve prognosis. This was a single-center retrospective study including all adult patients with at least 1 positive blood culture for A total of 222 episodes of candidemia were included. Most candidemias were of unknown origin (36%) or vascular catheter related (29%). Septic shock developed in 29% episodes. Overall, 14-day mortality rate was 23%. In univariate analyses, septic shock was associated with higher 14-day mortality, whereas catheter-related candidemia and early (<72 hours) interventions, such as appropriate antifungal therapy, source control, and infectious diseases consultation, were associated with improved survival. In a Cox multivariate regression model, septic shock (odds ratio [OR], 3.62 [95% confidence interval {CI}, 2.05-6.38]) was associated with higher mortality. While the impact of early antifungal therapy did not reach statistical significance, early (<72 hours) infectious diseases consultation (OR, 0.46 [95% CI, .23-.91]) and early source control (OR, 0.15 [95% CI, .08-.31]) were associated with better survival. Subanalyses showed that the benefits of early source control, specifically catheter removal, were significant among patients with sepsis or septic shock, but not among those without sepsis. These associations remained significant after exclusion of patients who died prematurely or were in palliative care. Early source control, in particular catheter removal, was a key determinant of outcome among candidemic patients with sepsis or septic shock.
Sections du résumé
Background
UNASSIGNED
Despite advances in diagnostic and therapeutic approaches, candidemia remains associated with high mortality rates. This study aimed at identifying predictors of mortality among patients with candidemia, with a focus on early interventions that can improve prognosis.
Methods
UNASSIGNED
This was a single-center retrospective study including all adult patients with at least 1 positive blood culture for
Results
UNASSIGNED
A total of 222 episodes of candidemia were included. Most candidemias were of unknown origin (36%) or vascular catheter related (29%). Septic shock developed in 29% episodes. Overall, 14-day mortality rate was 23%. In univariate analyses, septic shock was associated with higher 14-day mortality, whereas catheter-related candidemia and early (<72 hours) interventions, such as appropriate antifungal therapy, source control, and infectious diseases consultation, were associated with improved survival. In a Cox multivariate regression model, septic shock (odds ratio [OR], 3.62 [95% confidence interval {CI}, 2.05-6.38]) was associated with higher mortality. While the impact of early antifungal therapy did not reach statistical significance, early (<72 hours) infectious diseases consultation (OR, 0.46 [95% CI, .23-.91]) and early source control (OR, 0.15 [95% CI, .08-.31]) were associated with better survival. Subanalyses showed that the benefits of early source control, specifically catheter removal, were significant among patients with sepsis or septic shock, but not among those without sepsis. These associations remained significant after exclusion of patients who died prematurely or were in palliative care.
Conclusions
UNASSIGNED
Early source control, in particular catheter removal, was a key determinant of outcome among candidemic patients with sepsis or septic shock.
Identifiants
pubmed: 35959210
doi: 10.1093/ofid/ofac383
pii: ofac383
pmc: PMC9361172
doi:
Types de publication
Journal Article
Langues
eng
Pagination
ofac383Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
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