FACTORS ASSOCIATED WITH THE DEVELOPMENT OF CANDIDEMIA AND CANDIDEMIA-RELATED DEATH AMONG LIVER-TRANSPLANT RECIPIENTS

Objective The authors' objective was to identify factors associated wi th candidemia and candidemia-related death among adult liver transplan t recipients. Summary Background Data Invasive candidiasis is the most common severe fungal infection occurring after liver transplantation and is associated with high morbidity and mortality rates. Although ca ndidemia is not always found during invasive candidiasis, it has been considered as an indicator of invasive candidiasis in immunocompromise d patients. Methods A time-matched case-control study of 26 patients w ith candidemia, which was defined as the isolation of Candida from at least one blood culture, and 52 control patients without candidemia wa s reported. Two control patients were matched with each case patient r egarding time of transplantation and duration of follow-up. Results Be tween December 1985 and December 1992, candidemia developed in 1.4% of adult liver transplant recipients a median of 25 days after transplan tation (range, 2-1690 days). The overall mortality rate among patients with candidemia was 81%, and 71% of these deaths were related to cand idemia. Conditional logistic regression analysis was used to identify factors associated with candidemia, which were 1) hyperglycemia treate d with insulin up to 2 weeks before candidemia (odds ratio [OR], 16.15 ; p = 0.002), and 2) exposure to more than three different intravenous antibiotics before development of candidemia (OR, 11.15; p = 0.005). The variables predictive of death related to candidemia were abdominal surgery performed up to 1 week before candidemia (relative risk [RR], 7.25; p = 0.02), high white blood cell count(RR, 1.10; p = 0.01), low er platelet count (RR, 0.99; p = 0.02), and elevated AST with candidem ia(RR, 1.001; p = 0.01). Conclusions Hyperglycemia that requires insul in and exposure to more than three antibiotics are the factors associa ted with the development of candidemia in liver transplant recipients. When candidemia develops shortly after abdominal surgery and in patie nts with elevated AST, high white blood cell count, or low platelet co unt, it is associated with a high mortality rate.