Abstract
BACKGROUND AND PURPOSE: One of the most severe mycotic infections caused by Candida spp. is invasive candidiasis. According to the literature, among all healthcare- associated infections, it has the highest mortality rate. This study aimed to assess 30-day and overall mortality in invasive candidiasis and candidemia patients depending on the antifungal therapy (AFT) regimens. MATERIALS AND METHODS: This single-center retrospective study of 30-day survival was conducted at Clinical City Hospital No. 52, Moscow Healthcare Department in Moscow, Russia. The participants were 169 patients aged 19-94 years who had verified invasive candidiasis with candidemia during hospitalization in 2020-2023. This study included patients with Candida spp. isolated from blood culture using matrix-assisted laser desorption/ionization with time-of-flight mass spectrometry, and proven invasive candidiasis according to EORTC/MSG criteria. Patient survival analysis was performed using the Kaplan-Meier method, which is a nonparametric approach for estimating time- to-event. Risk of death was compared between the group of patients receiving AFT after pathogen verification and the group of patients receiving AFT before and after blood culture results. RESULTS: Based on the findings, the likelihood of death was lower in the group of patients who received AFT both after and before blood culture results compared to the group of patients who received it after verification of the diagnosis. By day 50 of hospitalization, the risks of death were comparable between the two groups. However, when analyzing the overall mortality, the odds of death in patients with AFT before and after receiving blood culture results were 2.56 times higher (OR=0.391; 95% CI: 0.177-0.865; p=0.019) compared with patients to whom antifungal therapy was prescribed only after blood culture results. CONCLUSION: This study provided the first data regarding the assessment of 30-day mortality and risk factors for death. Risk of 30-day mortality was lower in the group of patients receiving AFT both before and after the blood culture, but overall mortality in this group was higher, compared to patients who received AFT after the blood culture.