Time to blood culture positivity as a predictor of clinical outcome in patients with Candida albicans bloodstream infection

Cintia Zoya Nunes; Alexandre R Marra; Michael B Edmond; Elivane da Silva Victor; Carlos Alberto Pires Pereira

doi:10.1186/1471-2334-13-486

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Time to blood culture positivity as a predictor of clinical outcome in patients with Candida albicans bloodstream infection

Journal article

Open access

Peer reviewed

Time to blood culture positivity as a predictor of clinical outcome in patients with Candida albicans bloodstream infection

Cintia Zoya Nunes, Alexandre R Marra, Michael B Edmond, Elivane da Silva Victor and Carlos Alberto Pires Pereira

BMC infectious diseases, Vol.13(1), 486

10/20/2013

DOI: 10.1186/1471-2334-13-486

PMCID: PMC3854507

PMID: 24138760

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Abstract

Few studies have assessed the time to blood culture positivity as a predictor of clinical outcome in fungal bloodstream infections (BSIs). The purpose of this study was to evaluate the time to positivity (TTP) of blood cultures in patients with Candida albicans BSIs and to assess its impact on clinical outcome. A historical cohort study with 89 adults patients with C. albicans BSIs. TTP was defined as the time between the start of incubation and the time that the automated alert signal indicating growth in the culture bottle sounded. Patients with BSIs and TTPs of culture of ≤ 36 h (n=39) and >36 h (n=50) were compared. Septic shock occurred in 46.2% of patients with TTPs of ≤ 36 h and in 40.0% of patients with TTP of >36 h (p=0.56). A central venous catheter source was more common with a BSI TTP of ≤ 36 h (p=0.04). Univariate analysis revealed that APACHE II score ≥ 20 at BSI onset, the development of at least one organ system failure (respiratory, cardiovascular, renal, hematologic, or hepatic), SOFA at BSI onset, SAPS II at BSI onset, and time to positivity were associated with death. By using logistic regression analysis, the only independent predictor of death was time to positivity (1.04; 95% CI, 1.0-1.1, p=0.035), with the chance of the patient with C. albicans BSI dying increasing 4.0% every hour prior to culture positivity. A longer time to positivity was associated with a higher mortality for Candida albicans BSIs; therefore, initiating empiric treatment with antifungals may improve outcomes.

Candidemia - microbiology

Humans

Middle Aged

Male

Treatment Outcome

Shock, Septic - diagnosis

Antifungal Agents - therapeutic use

Candidemia - diagnosis

Shock, Septic - microbiology

Young Adult

Candidemia - drug therapy

Mycology - methods

Candida albicans - isolation & purification

Shock, Septic - blood

Adolescent

Aged, 80 and over

Adult

Female

Aged

Candidemia - blood

Cohort Studies

Details

Title: Subtitle: Time to blood culture positivity as a predictor of clinical outcome in patients with Candida albicans bloodstream infection
Creators: Cintia Zoya Nunes
Alexandre R Marra - Infectious Diseases Division, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. alexandre.marra@einstein.br
Michael B Edmond
Elivane da Silva Victor
Carlos Alberto Pires Pereira
Resource Type: Journal article
Publication Details: BMC infectious diseases, Vol.13(1), 486
DOI: 10.1186/1471-2334-13-486
PMID: 24138760
PMCID: PMC3854507
NLM abbreviation: BMC Infect Dis
ISSN: 1471-2334
eISSN: 1471-2334
Publisher: England
Language: English
Date published: 10/20/2013
Academic Unit: Internal Medicine
Record Identifier: 9983905640602771

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