Candidemia in adult patients with alcoholism: a retrospective cohort study in Finland from 2007 to 2016.

Abstract

Background: Candidemia is a life-threatening, typically nosocomial infection, which often occurs with critical illness and immunosuppression. Alcoholism has not been associated with candidemia risk or outcomes. However, alcoholism is a common comorbidity in hospitalised patients, excess alcohol consumption has detrimental effects on the immune system, and alcoholism is associated with poor outcomes from bacteraemia, sepsis and bacterial pneumonia. We aimed to investigate the patient and disease characteristics, treatment, outcomes, and Candida species distribution in patients with alcoholism.

Methods: We collected retrospective data on cases of candidemia in adults from Southern Finland between 2007 and 2016. Cases were stratified by alcoholism.

Results: We identified a total of 329 patients with candidemia, of which 69 (21%) had alcoholism. Patients with alcoholism were younger and had fewer serious or life-threatening comorbidities. Classical risk factors for candidemia were equally or less prevalent in patients with alcoholism than in those without, including malignancy (20% vs. 34%), central venous catheter (48% vs. 50%), and gastrointestinal surgery (20% vs. 24%). The majority of candidemia cases were nosocomial (92%) without significant differences between patient cohorts. Candidemia diagnosis in the ICU was more common in patients with alcoholism than in those without (19% vs. 10%). Central venous catheters were removed (61%) and antifungal therapy was initiated promptly in patients with alcoholism. The 30-day mortality of patients with and without alcoholism was equivalent (29% vs. 31%).

Conclusions: A significant proportion of patients with candidemia had comorbid alcoholism. Patients with alcoholism did not have significantly different outcomes from patients without alcoholism.