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Glucocorticoid use and parenteral nutrition are risk factors for catheter-related Candida bloodstream infection: a retrospective study Cover

Glucocorticoid use and parenteral nutrition are risk factors for catheter-related Candida bloodstream infection: a retrospective study

Open Access
|Jun 2024

Figures & Tables

Table 1.

Baseline characteristics of patients with Candida CRBSI and non-Candida CRBSI

This table compares demographic and clinical features of patients with Candida and bacterial catheter-related bloodstream infections (CRBSI). It includes variables like age, sex, underlying diseases, and catheter type. No significant differences are found for most characteristics (e.g., age, cerebrovascular accidents, malignant tumors, acute leukemia).
CharacteristicsCandida CRBSI (n = 33)Bacterial CRSBI (n = 264)χ2/tP
Sex (male), n (%)20 (60.6%)177 (67.0%)0.5450.461
Age, mean (year)67.79 ± 21.0569.86 ± 18.070.544
Underlying diseases, n (%)
Cerebrovascular accidents12 (36.4%)131 (49.6%)2.0650.151
Malignant tumors5 (15.2%)79 (29.9%)3.1560.076
Acute leukemia7 (22.2%)91 (34.5%)2.3320.127
Chronic obstructive pulmonary disease3 (9.09%)57 (21.6%)2.1212.121
Chronic kidney disease8 (24.2%)89 (33.3%)1.9120.167
Infectious shock13 (39.4%)135 (51.1%)1.6180.203
Severe trauma3 (9.1%)59 (22.3%)3.1210.077
Severe pancreatitis3 (9.1%)53 (20.1%)2.5670.109
Diabetes13 (39.4%)143 (54.2%)2.5670.109
Catheter type, n (%)
Single-lumen CVC catheter14 (42.4%)155 (58.7%)3.1730.075
Double-lumen CVC catheter11 (33.3%)59 (22.3%)0.1510.698
Single-lumen PICC catheter8 (24.2%)99 (37.5%)2.2370.135
Catheter retention site n (%)
CVC25 (75.8%)175 (66.3%)1.1960.274
Subclavian vein8 (32.0%)29 (16.6%)3.4540.063
Internal jugular vein11 (44.0%)99 (56.6%)01.3970.237
Femoral vein6 (24.0%)57 (32.6%)0.7450.388
PICC8 (24.2%)89 (32.1%)1.0540.305
Cubital vein5 (62.5%)67 (75.35%)0.6270.429
Median cubital vein3 (37.5%)22 (24.7%)0.6270.429

[i] CRBSI, catheter-related bloodstream infections; CVC, central venous catheter, PICC, peripherally inserted central venous catheters.

Table 2.

Univariate analysis

This table shows the comparison of risk factors between Candida and bacterial infections. Significant factors associated with Candida CRBSI include: Parenteral nutrition (p < 0.001) Catheter indwelling ≥ 14 days (p = 0.004) MODS (p = 0.010) Glucocorticoid use (p < 0.001) Immunosuppressant use (p = 0.001) Granulocytopenia (p = 0.002)
Risk factorCandida infection (n = 33)Bacterial infection (n = 264)P
Mechanical ventilation (n, %)12 (36.4%)104 (39.4%)0.737
Hospital stay >15 d (n, %)28 (84.8%)204 (77.3%)0.321
Broad-spectrum antibiotics (n, %)31 (93.9%)232 (87.9%)0.396*
Parenteral nutrition (n, %)30 (90.9%)104 (39.4%)< 0.001
Age >65 years (n, %)28 (84.8%)208 (78.8%)0.416
Diabetes or hyperglycemia (n, %)18 (54.5%)113 (42.8%)0.200
>4 underlying diseases (n, %)28 (84.8%)195 (73.9%)0.169
Catheter indwelling ≥14 d (n, %)31 (93.9%)185 (70.1%)0.004
Renal inadequacy (n, %)15 (45.5%)127 (48.1%)0.774
MODS (n, %)14 (42.4%)58 (22.0%)0.010
Glucocorticoids (>400 mg hydrocortisone/d; n, %)28 (84.8%)74 (28.0%)< 0.001
Immunosuppressant/chemoradiotherapy (n, %)12 (36.4%)37 (14.0%)0.001
Granulocytopenia (n, %)8 (24.2%)16 (6.1%)0.002*
Major surgery (n, %)3 (9.1%)16 (6.1%)0.454*
Urinary catheterization (n, %)19 (57.6%)125 (47.3%)0.268
Blood or albumin transfusion (n, %)32 (97.0%)228 (86.4%)0.096*

* Fisher's exact rate method; others, chi-square test.

CRBSI, catheter-related bloodstream infections, MODS, multiple organ dysfunction syndrome.

Table 2.

Multivariate analysis

Identifies independent risk factors for Candida CRBSI. Parenteral nutrition (OR 5.400, p = 0.0175) and glucocorticoid use (OR 10.313, p = 0.005) are significant. Other variables like catheter indwelling time and immunosuppressant use are not significant.
Risk factorOR95% CIP
Parenteral nutrition5.4000.472–61.7520.0175
Time of catheter indwelling ≥14 d0.4880.043–5.4860.561
Immunosuppressant/chemoradiotherapy0.8000.188–3.4010.763
MODS0.3460.100–1.1980.094
Glucocorticoids10.3132.032–52.3300.005
Granulocytopenia2.6250.670–10.2800.166

[i] CI, confidence interval; CRBSI, catheter-related bloodstream infections, d, days, MODS, multiple organ dysfunction syndrome, OR, odds ratio.

Table 4.

Comparison of mortality between Candida CRBSI and Bacterial CRBSI

Mortality is significantly higher in Candida CRBSI (51.52%) compared to bacterial CRBSI (21.60%). Chi-square value = 14.041, p = 0.001.
Candida CRBSI (n = 33)Bacterial CRBSI (n = 264)χ2P
Number of deaths (rates, %)17 (51.52)57 (21.60)14.0410.001
Table 5.

Overall survival of patients with Candida CRBSI

Compares survival based on treatment timing (catheter removal and antifungal treatment). Timely catheter removal + appropriate antifungal treatment has the best survival rate (88.89%). Delayed catheter removal + inappropriate antifungal treatment has the worst outcome (0% survival). Time for fever reduction and blood culture to turn negative is shorter with timely catheter removal and appropriate treatment.
Fever reduction time (d)Time for blood culture to turn negative (d)
Timely catheter removal + appropriate antifungal treatment (n = 9)8 (88.89)1 (11.11)5.50 ± 2.274.38 ± 1.60
Timely catheter removal + inappropriate antifungal treatment (n = 7)3 (42.86)4 (57.14)11.33 ± 1.53*10.33 ± 2.52#
Delayed catheter removal + appropriate antifungal treatment (n = 11)5 (45.45)6 (54.55)9.60 ± 2.41*8.80 ± 2.28#
Delayed catheter removal + inappropriate antifungal treatment (n = 6)06 (100.00)
Total numbers (n = 33)16 (48.48)17 (51.52)7.88 ± 3.266.88 ± 3.22

Overall survival was compared using Fisher's exact rate method, P = 0.006.

* P < 0.01 vs./Timely catheter removal + appropriate antifungal treatment group.

# P < 0.01 vs. Timely catheter removal + appropriate antifungal group.

CRBSI, catheter-related bloodstream infections.

DOI: https://doi.org/10.2478/abm-2024-0016 | Journal eISSN: 1875-855X | Journal ISSN: 1905-7415
Language: English
Page range: 109 - 115
Published on: Jun 28, 2024
Published by: Chulalongkorn University
In partnership with: Paradigm Publishing Services

© 2024 Lipeng Huang, Shanshan Li, Ronglin Jiang, Shu Lei, Jiannong Wu, Liquan Huang, Meifei Zhu, published by Chulalongkorn University
This work is licensed under the Creative Commons Attribution 4.0 License.