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Journal of Clinical Microbiology, June 2007, p. 1843-1850, Vol. 45, No. 6
0095-1137/07/$08.00+0     doi:10.1128/JCM.00131-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Biofilm Production by Candida Species and Inadequate Antifungal Therapy as Predictors of Mortality for Patients with Candidemia{triangledown}

Mario Tumbarello,1 Brunella Posteraro,2 Enrico Maria Trecarichi,1 Barbara Fiori,2 Marianna Rossi,1 Rosaria Porta,2 Katleen de Gaetano Donati,1 Marilena La Sorda,2 Teresa Spanu,2 Giovanni Fadda,2 Roberto Cauda,1 and Maurizio Sanguinetti2*

Institutes of Infectious Diseases,1 Microbiology, Università Cattolica del Sacro Cuore, Rome, Italy2

Received 18 January 2007/ Returned for modification 14 March 2007/ Accepted 17 April 2007

Nosocomial Candida bloodstream infections rank among infections with highest mortality rates. A retrospective cohort analysis was conducted at Catholic University Hospital to estimate the risk factors for mortality of patients with candidemia. We reviewed records for patients with a Candida bloodstream infection over a 5-year period (January 2000 through December 2004). Two hundred ninety-four patients (42.1% male; mean age ± standard deviation, 65 ± 12 years) were studied. Patients most commonly were admitted with a surgical diagnosis (162 patients [55.1%]), had a central venous catheter (213 [72.4%]), cancer (118 [40.1%]), or diabetes (58 [19.7%]). One hundred fifty-four (52.3%) patients died within 30 days. Of 294 patients, 168 (57.1%) were infected by Candida albicans, 64 (21.7%) by Candida parapsilosis, 28 (9.5%) by Candida tropicalis, and 26 (8.8%) by Candida glabrata. When fungal isolates were tested for biofilm formation capacity, biofilm production was most commonly observed for isolates of C. tropicalis (20 of 28 patients [71.4%]), followed by C. glabrata (6 of 26 [23.1%]), C. albicans (38 of 168 [22.6%]), and C. parapsilosis (14 of 64 [21.8%]). Multivariable analysis identified inadequate antifungal therapy (odds ratio [OR], 2.35; 95% confidence interval [95% CI], 1.09 to 5.10; P = 0.03), infection with overall biofilm-forming Candida species (OR, 2.33; 95% CI, 1.26 to 4.30; P = 0.007), and Acute Physiology and Chronic Health Evaluation III scores (OR, 1.03; 95% CI, 1.01 to 1.15; P < 0.001) as independent predictors of mortality. Notably, if mortality was analyzed according to the different biofilm-forming Candida species studied, only infections caused by C. albicans (P < 0.001) and C. parapsilosis (P = 0.003) correlated with increased mortality. Together with well-established factors, Candida biofilm production was therefore shown to be associated with greater mortality of patients with candidemia, probably by preventing complete organism eradication from the blood.

* Corresponding author. Mailing address: Institute of Microbiology, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy. Phone: 39-06-3051152. Fax: 39-06-3054218. E-mail: msanguinetti{at}rm.unicatt.it

{triangledown} Published ahead of print on 25 April 2007.

Journal of Clinical Microbiology, June 2007, p. 1843-1850, Vol. 45, No. 6
0095-1137/07/$08.00+0     doi:10.1128/JCM.00131-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



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