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Volume 27, Number 6—June 2021
CME ACTIVITY - Research

HIV Infection as Risk Factor for Death among Hospitalized Persons with Candidemia, South Africa, 2012–2017

Nelesh P. GovenderComments to Author , Jim Todd, Jeremy Nel, Mervyn Mer, Alan Karstaedt, Cheryl Cohen, and for GERMS-SA1
Author affiliations: University of Cape Town, Cape Town, South Africa (N.P. Govender); University of the Witwatersrand, Johannesburg (N.P. Govender, J. Nel, M. Mer, A. Karstaedt, C. Cohen); National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa (N.P. Govender, C. Cohen); London School of Hygiene and Tropical Medicine, London, UK (J. Todd)

Main Article

Table 2

Risk factors for in-hospital death among 1,040 persons with culture-confirmed candidemia at sentinel hospitals, South Africa, 2012–2017*

Variable No. patients† No. deaths Case-fatality ratio, % Crude OR (95% CI) LRT p value
HIV status 1,040
Seronegative 614 230 37 Referent <0.001
Seropositive
426
228
54
1.92 (1.50–2.47)

Age group, y 1,037
<18 226 46 20 Referent <0.001
18–44 427 199 47 3.42 (2.35–4.97)
45–64 283 152 54 4.54 (3.04–6.77)
>65 101 61 60 5.97 (3.57–9.97)
Missing
3




Sex 1,040
F 498 215 43 Referent 0.59
M
542
243
45
1.07 (0.84–1.37)

Province 1,040
Other province 495 232 50 Referent 0.21
Gauteng
545
226
46
0.86 (0.67–1.09)

Year 1,040
2012 139 52 37 Referent 0.05
2013 185 74 40 1.11 (0.71–1.75)
2014 100 51 51 1.74 (1.03–2.93)
2015 91 38 42 1.20 (0.70–2.06)
2016 273 115 42 1.22 (0.80–1.85)
2017
252
128
51
1.73 (1.13–2.64)

Community-onset infection, <72 h preadmission 1,035
No 747 334 45 Referent 0.38
Yes 288 120 42 0.88 (0.67–1.16)
Missing
3




ICU admission 1,023
No 509 202 40 Referent 0.005
Yes 514 249 48 1.43 (1.11–1.83)
Missing
17




CVC in situ 1,011
No 466 193 41 Referent 0.21
Yes 545 247 45 1.17 (0.91–1.51)
Missing
29




Total parenteral nutrition 1,004
No 759 333 44 Referent 0.70
Yes 245 104 42 0.94 (0.71–1.26)
Missing
36




Quick Pitt score >2‡ 652
No 503 188 37 Referent <0.001
Yes 149 89 60 2.49 (1.71–3.61)
Missing
388




Candida species 946
C. albicans 425 221 52 Referent <0.001
Other Candida species 521 204 39 0.59 (0.46–0.77)
Missing
94




Mixed Candida species 1,040
No 1,007 445 44 Referent 0.58
Yes
33
13
40
0.82 (0.40–1.67)

Candida species resistant to fluconazole, voriconazole, or an echinocandin§ 764
No 610 283 46 Referent 0.35
Yes 154 65 42 0.84 (0.59–1.21)
Missing
276




Receipt of systemic antifungal treatment 1,010
No 310 187 60 Referent <0.001
Yes 700 254 36 0.37 (0.28–0.49)
Missing
30




Inappropriate antifungal treatment for candidemia¶ 419
No 381 140 37 Referent 0.52
Yes 38 16 42 1.25 (0.64–2.46)
Missing
621




Removal of CVC 488
No 127 71 56 Referent 0.001
Yes 361 141 39 0.51 (0.34–0.76)
Missing 552

*CVC, central venous catheter; ICU, intensive care unit; LRT, likelihood ratio test; OR, odds ratio. 
†Total numbers for each category indicate number of patients for whom that information was available.
‡Quick Pitt score was calculated as the sum of individual scores for temperature <35°C (1), systolic blood pressure <90 mm Hg (1), cardiac arrest (1), mechanical ventilation (1), and altered mental status (1) at time of diagnosis of candidemia. 
§Resistance was defined on the basis of Clinical and Laboratory Standards Institute Candida species–specific breakpoints (18). 
¶Inappropriate treatment was defined as treatment with an antifungal agent to which the Candida species was resistant.

Main Article

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Main Article

1Members of GERMS-SA are listed at the end of this article.

Page created: April 13, 2021
Page updated: May 19, 2021
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