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.