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Survival time from diagnosis of candidemia: An application of survival methods for epidemiology to the Mycoses Study Group multi-center observational study of hospitalized patients with candidemia

Thompson, Nicola Dawn
http://rave.ohiolink.edu/etdc/view?acc_num=osu1117558533

Abstract Details

2005, Doctor of Philosophy, Ohio State University, Public Health.
The present study analyzes the relationship between species-specific candidemia and the occurrence of death during three months of post-diagnosis follow-up while controlling for the effect of confounding variables. Data used for this study come from the NIH, NIAID, Mycoses Study Group study number 34 – a large multi-center, prospective, observational study of hospitalized patients with candidemia in the United States between February 1995 and November 1997. A total of 1,570 cases were identified with one or more positive blood cultures for Candida, 657 (42%) deaths occurred during the three-month follow-up period. Proportional hazards regression was performed for each species group of identified. Differences in the risk factor variables identified within each group and estimates of the reported hazard ratios were compared. Species-specific death rates were compared by calculating Kaplan-Meier estimates of survival time. Descriptive statistics revealed that non-albicans species were predominantly (64%) the cause of candidemia. The most frequently isolated non-albicans species was C. glabrata (25%) followed by C. troplicalis (14%), C. parapsilosis (14%) and C. krusei (3%). Cox proportional hazards regression identified unique species interactions with the predictor variables. Of particular interest was the elevated hazard ratio for HIV infection among patients with C. albicans (HR = 1.9, 95% CI: 1.5 – 4.3), and cancer (HR = 1.7, 95% CI: 1.0 – 3.0) and for prophylactic systemic antifungal therapy among patients with C. tropicalis. Kaplan-Meier estimates of survival during the 3-month observation period for untreated candidemia were lowest for patients with C. glabrata (65%) and C. tropicalis (77%), and highest for patients with C. albicans (88%) and C. parapsilosis (94%) group. The descriptive results confirm the epidemiologic shift towards non-albicans species. They also suggest that species-specific risk factors for mortality exist, that candidemia is an independent cause of mortality, and that survival rates are different among the Candida species evaluated. Not all candidemia infections are the same. Treatment and intervention strategies that aim to reduce mortality should consider not only the underlying disease status of the patient but also the species of Candida causing infection, as well as potential interactions between these two factors.
Judith Schwartzbaum (Advisor)
108 p.
Health Sciences, Public Health
Candidemia; Epidemiology; Survival time

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Citations

  • Thompson, N. D. (2005). Survival time from diagnosis of candidemia: An application of survival methods for epidemiology to the Mycoses Study Group multi-center observational study of hospitalized patients with candidemia [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1117558533

    APA Style (7th edition)

  • Thompson, Nicola. Survival time from diagnosis of candidemia: An application of survival methods for epidemiology to the Mycoses Study Group multi-center observational study of hospitalized patients with candidemia. 2005. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1117558533.

    MLA Style (8th edition)

  • Thompson, Nicola. "Survival time from diagnosis of candidemia: An application of survival methods for epidemiology to the Mycoses Study Group multi-center observational study of hospitalized patients with candidemia." Doctoral dissertation, Ohio State University, 2005. http://rave.ohiolink.edu/etdc/view?acc_num=osu1117558533

    Chicago Manual of Style (17th edition)

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This open access ETD is published by The Ohio State University and OhioLINK.