Candidemia in Older Adults: What Are the Risk Factors for Mortality?

Abstract

Introduction: As the aging population rises, an increase in Candida infections has also been observed. The aim of this study was to determine the risk factors for early and late mortality due to candidemia in older patients. Materials and Methods: This retrospective observational study included patients aged 65 years and older who were hospitalized in two tertiary care centers and had Candida-positive blood culture between January 1, 2019 and June 1, 2021. Results: Mean age of the 81 patients included in the study was 77.1 ± 7.1 years and 41 (50.6%) were females. The most commonly identified species were Candida albicans and Candida parapsilosis. After candidemia, early (seven-day) mortality occurred in 18 patients (22.2%) and late (30-day) mortality in 42 patients (51.9%). Significant risk factors for early mortality were diabetes mellitus (p= 0.021), hematological malignancy (p= 0.033), late central venous catheter (CVC) removal (p< 0.001), and initiating antifungal therapy more than 48 hours after the first positive blood culture (p< 0.001). Significant risk factors for late mortality were higher comorbidity index (p= 0.018), late CVC removal (p< 0.002), and initiating antifungal therapy after 48 hours (p< 0.001). Late CVC removal was independently associated with a higher risk of early mortality (OR= 21.976, 95% CI= 2.057-234.739, p= 0.011) and higher risk of late mortality (OR= 7.234, 95% CI= 1.820-28.754, p= 0.005). Conclusion: Time to initiation of antifungal therapy and early CVC removal are important factors for improving outcomes in older adults with high mortality risk for candidemia.

Keywords

• candidemia
• mortality
• elderly