TY - JOUR
T1 - Septic shock attributed to Candida infection
T2 - Importance of empiric therapy and source control
AU - Kollef, Marin
AU - Micek, Scott
AU - Hampton, Nicholas
AU - Doherty, Joshua A.
AU - Kumar, Anand
N1 - Funding Information:
Financial support. This work was supported by an unrestricted grant from Astellas. The sponsor had no role in any aspect of this investigation to include study conception and design, statistical analysis, and critical revision of the manuscript. Dr. Kollef’s efforts were supported by the Barnes-Jewish Hospital Foundation. The research was supported by an unrestricted grant from Astellas.
PY - 2012/6/15
Y1 - 2012/6/15
N2 - Background. Delayed treatment of candidemia has previously been shown to be an important determinant of patient outcome. However, septic shock attributed to Candida infection and its determinants of outcome have not been previously evaluated in a large patient population.Methods.A retrospective cohort study of hospitalized patients with septic shock and blood cultures positive for Candida species was conducted at Barnes-Jewish Hospital, a 1250-bed urban teaching hospital (January 2002-December 2010).Results.Two hundred twenty-four consecutive patients with septic shock and a positive blood culture for Candida species were identified. Death during hospitalization occurred among 155 (63.5) patients. The hospital mortality rate for patients having adequate source control and antifungal therapy administered within 24 hours of the onset of shock was 52.8 (n = 142), compared to a mortality rate of 97.6 (n = 82) in patients who did not have these goals attained (P <. 001). Multivariate logistic regression analysis demonstrated that delayed antifungal treatment (adjusted odds ratio [AOR], 33.75; 95 confidence interval [CI], 9.65-118.04; P =. 005) and failure to achieve timely source control (AOR, 77.40; 95 CI, 21.52-278.38; P =. 001) were independently associated with a greater risk of hospital mortality.Conclusions.The risk of death is exceptionally high among patients with septic shock attributed to Candida infection. Efforts aimed at timely source control and antifungal treatment are likely to be associated with improved clinical outcomes.
AB - Background. Delayed treatment of candidemia has previously been shown to be an important determinant of patient outcome. However, septic shock attributed to Candida infection and its determinants of outcome have not been previously evaluated in a large patient population.Methods.A retrospective cohort study of hospitalized patients with septic shock and blood cultures positive for Candida species was conducted at Barnes-Jewish Hospital, a 1250-bed urban teaching hospital (January 2002-December 2010).Results.Two hundred twenty-four consecutive patients with septic shock and a positive blood culture for Candida species were identified. Death during hospitalization occurred among 155 (63.5) patients. The hospital mortality rate for patients having adequate source control and antifungal therapy administered within 24 hours of the onset of shock was 52.8 (n = 142), compared to a mortality rate of 97.6 (n = 82) in patients who did not have these goals attained (P <. 001). Multivariate logistic regression analysis demonstrated that delayed antifungal treatment (adjusted odds ratio [AOR], 33.75; 95 confidence interval [CI], 9.65-118.04; P =. 005) and failure to achieve timely source control (AOR, 77.40; 95 CI, 21.52-278.38; P =. 001) were independently associated with a greater risk of hospital mortality.Conclusions.The risk of death is exceptionally high among patients with septic shock attributed to Candida infection. Efforts aimed at timely source control and antifungal treatment are likely to be associated with improved clinical outcomes.
UR - http://www.scopus.com/inward/record.url?scp=84861497629&partnerID=8YFLogxK
U2 - 10.1093/cid/cis305
DO - 10.1093/cid/cis305
M3 - Article
C2 - 22423135
AN - SCOPUS:84861497629
VL - 54
SP - 1739
EP - 1746
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
SN - 1058-4838
IS - 12
ER -