Invasive candidiasis in the elderly: a single-center, retrospective cohort study / 中华老年医学杂志

ABSTRACT

Objective:To investigate the clinical and mycological characteristics, treatment and prognosis of invasive candidiasis(IC)in the elderly.Methods:This retrospective study included aged patients(≥65 years)admitted to the Peking University First Hospital between January, 2010 and December, 2019, who were diagnosed with IC based on positive culture results.The infecting strains were re-identified and their antifungal drug resistance was tested.The clinical and mycological characteristics, treatment and prognosis information of the elderly patients were collected and compared with those of non-elderly adults.Results:A total of 99 aged patients were included, with a median age of 78(70-83)years and a male-to-female ratio of 2.1∶1.0.The elderly accounted for 62.7%(99/158)of the adult IC patients.Compared with their younger counterparts, elderly patients were more likely to need medium-to long-term hospitalization and intensive care unit(ICU)stay, and to show concurrent heart failure, respiratory failure or renal failure, to require mechanical ventilation, and to show deep-seated bacterial infections and multifocal Candida colonization, especially for those with previous fluconazole exposure( P<0.05). Bloodstream was the most common Candida transmission route(71/99, 71.7%)and Candida albicans was the most prevalent species(47/99, 47.5%). Antifungal resistance was highest for fluconazole(17/117, 14.5%)and voriconazole(15/117, 12.8%). No significant difference was found between elderly patients and non-elderly patients in terms of infected sites, Candida species, and antifungal resistance( P>0.05). A total of 86 patients(86.9%)received systemic antifungal treatment and fluconazole was the most commonly used drug(35/86, 40.7%). The thirty-day all-cause mortality in aged IC patients was 32.6%(29/89), significantly higher than in younger patients( P=0.022). Logistic regression analysis revealed that advanced age( OR=1.12, 95% CI 1.06-1.20, P<0.001), renal failure( OR=4.81; 95% CI 1.65-14.03; P=0.004), and a high Candida score( OR=1.81, 95% CI 1.06-3.11, P=0.031)significantly increased the risk of death. Conclusions:Elderly patients were the main affected population of IC, and the mortality of IC steadily increases with age.Treatment for aged IC patients should be proactive and cautious.