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Candida Score: a predictor of mortality in patients with candidemia
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  • Deven Juneja,
  • Ravi Jain,
  • Omender Singh,
  • Apurba Borah
Deven Juneja
Max Super Speciality Hospital Saket
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Ravi Jain
Mahatma Gandhi Medical College and Hospital

Corresponding Author:[email protected]

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Omender Singh
Max Super Speciality Hospital Saket
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Apurba Borah
Narayana Superspeciality Hospital - North Guwahati
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Abstract

Background: Candida score has been developed and used for identifying patients at risk for developing Candida infections. However, its usefulness in predicting outcomes of patients with candidemia has not been evaluated. We aimed to determine the risk factors for mortality in patients with candidemia admitted to an Indian medical intensive care unit (ICU). Methods: We conducted a retrospective cohort analysis of 56 patients with candidemia presented in 18 months duration. Baseline patient characteristics, ICU course, and outcome were noted and Candida score was calculated. We conducted an analysis based on the primary outcome measure of ICU mortality. Results: Out of 3,142 ICU admissions, the incidence of candidemia was 17.8/1,000 admissions. The mean interval between ICU admission and candidemia was 12.9 ± 14.4 days. C. tropicalis was the commonest species isolated from 28.6% isolates, followed by Candida albicans (21.4%) and C. glabrata (12.5%). The mean length of ICU stay was 22.9 ± 28 days and hospital stay was 30.1 ± 30.2 days. Crude ICU mortality was 33.93%. There was no statistically significant difference between mortality of patients with albicans and non-albicans candidemia (p=0.732). On multivariate analysis, only two factors, previous antifungal therapy (p=0.004, OR=101.4, 95% CI=4.52-227.7) and Candida score >3 (p=0.028, OR=13.2, 95% CI=1.3-125) were found to be independently predicting mortality. Conclusion: Candida infection is generally late-onset and is associated with a prolonged ICU and hospital stay, and high mortality. Candida non-albicans infection was more common but there was no difference in mortality among patients with C. albicans and non-albicans infection. Previous antifungal therapy and Candida score were found to be independently predicting mortality.