Title : Risk Factors, Sensi0vity Pa4ern and Clinical Outcomes of Candidemia among Pa0ents Receiving Parenteral Nutri0on Admi4ed at St. Luke’s Medical Center
Abstract:
Candidemia is often associated with high rates of morbidity, mortality and long hospital stays especially on critical ill patients. Parenteral nutrition is an established risk factor in developing candidemia.
Since there are limited local studies on candidemia in parenteral nutrition recipients, the study aimed to determine the incidence, risk factors, clinical outcome, Candida isolates and sensitivity pattern of candidemia among patients receiving parenteral nutrition in St. Luke’s Medical Center. A retrospective cohort design was used in the study using medical databases. Out of the 204 subjects, 45 were diagnosed with Candidemia (22%). Risk factors found to be significant in the candidemia group were the following:
kidney failure (24.45% vs 10.07; p-value = 0.034); episode of abdominal perforation/trauma/bleeding (57.78% vs 39.62%; p-value = 0.041); use of broad-spectrum antibiotic (100% vs 83.65%; p-value = 0.002); and severity of illness (severe 55.56% vs non-severe 28.3%; p-value = 0.001). Subjects with candidemia were found to have longer days of PN compared with the non-candidemia subjects (mean 20 days vs 7 days). Mortality was noted to be higher in candidemia group compared to non-candidemia group (35.56% vs 27.67%, p-value = <0.001). In candidemia group, 35.56% expired, 35.56% had an episode of relapsed of candidemia during the same hospital admission and 28.89% recovered and discharged.
There were no significant risk factors noted associated with mortality that had candidemia. Days to develop candidemia from the start of PN initiation had an average of 14 days and does not significantly contribute to the subject’s outcome (p-value = 0.566). Candida parapsilosis was the most common isolates in the candidemia group
(n=13, 28.89%) followed by Candida tropicalis (n=9, 20%). Only 66.67% of Candida isolates were sensitive to fluconazole and majority of Candida isolates were sensitive to voriconazole indicating that azoles may still be used as a first line drug for candidemia.
In conclusion, incidence rate of candidemia in parenteral nutrition recipients is around 22%. Risk factors to be significant in acquiring candidemia were as follows: kidney failure, episode of abdominal perforation/trauma/bleeding, use of broad-spectrum antibiotics, use of central line, duration of parenteral nutrition and severity of illness. There was noted to be a higher mortality rate in patients who are receiving parenteral nutrition with candidemia than in non-candidemia group. There were no noted risk factors associated with mortality in parenteral nutrition recipients who had candidemia. Days to develop candidemia from the start of parenteral nutrition had an average of 14 days. Candida parapsilosis was the most common isolates in the candidemia group. Majority of the isolates have good sensitivity to azoles indicating that it may still be utilized as the first line of drug for candidemia.
Audience takeaway:
• Determining incidence, demographics and clinical profile, associated risk factors of patients on parenteral nutrition diagnosed with candidemia in a developing country.
• Determine percentage distribution of candidemia according to the Candida species and sensitivity to azoles.
• To give insights to clinicians in treating patient with Candidemia residing in a low resource country.
• To screen patients on parenteral nutrition who are at risk of developing candidemia.
