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Volume 27, Number 6—June 2021

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 1

Comparison of baseline characteristics by HIV infection status among 1,040 persons with culture-confirmed candidemia at sentinel hospitals, South Africa, 2012–2017*

Variable No. patients† HIV-seronegative, n = 614 HIV-seropositive, n = 426 p value‡
Median age, y (IQR)
38.8 (16.1–57.6)
36.4 (27.6–46.1)
Age group, y 1,037
<18 226 161 (71) 65 (29) <0.001
18–44 427 190 (45) 237 (55)
45–64 283 173 (61) 110 (39)
>65 101 88 (87) 13 (13)

Sex 1,040
F 498 272 (55) 226 (45) 0.005
342 (63)
200 (37)

Province 1,040
Other province 495 297 (60) 198 (40)
317 (58)
228 (42)
Year 1,040
2012 139 96 (69) 43 (31) <0.001
2013 185 117 (63) 68 (37)
2014 100 48 (48) 52 (52)
2015 91 45 (49) 46 (51)
2016 273 175 (64) 98 (36)
133 (53)
119 (47)

Community-onset infection, <72 h preadmission 1,035
No 747 454 (61) 293 (39) 0.05
Yes 288 156 (54) 132 (46)

ICU admission 1,023
No 509 262 (51) 247 (49) <0.001
Yes 514 339 (66) 175 (34)

CVC in situ 1,011
No 466 243 (52) 223 (48) <0.001
Yes 545 354 (65) 191 (35)

Total parenteral nutrition 1,004
No 759 425 (56) 334 (44) <0.001
Yes 245 167 (68) 78 (32)

Quick Pitt score > 652
No 503 278 (55) 225 (45) 0.27
Yes 149 90 (60) 59 (40)

Candida species 946
C. albicans 425 221 (52) 204 (48) <0.001
Other Candida species# 521 336 (65) 185 (35)

Mixed Candida species 1,040
No 1,007 590 (59) 417 (41) 0.11**
24 (73)
9 (27)

Candida species resistant to fluconazole, voriconazole, or an echinocandin†† 764
No 610 345 (57) 265 (43) <0.001
Yes 154 114 (74) 40 (26)

Receipt of systemic antifungal treatment 1,010
No 310 153 (49) 157 (51) <0.001
Yes 700 442 (63) 258 (37)

Inappropriate antifungal treatment for candidemia‡‡ 419
No 381 247 (65) 134 (35) 0.21**
Yes 38 29 (76) 9 (24)

Removal of CVC 488
No 127 75 (59) 52 (41) 0.08
Yes 361 244 (68) 117 (32)
Missing 552

*Values are no. (%) unless otherwise indicated. CVC, central venous catheter; ICU, intensive care unit.
†Total numbers for each category indicate number of patients for whom that information was available.
‡p values by Pearson’s χ2 test unless otherwise indicated. 
§By Wilcoxon rank-sum test. 
¶Quick Pitt score was calculated as the sum of individual scores for temperature <35oC (1), systolic blood pressure <90 mm Hg (1), cardiac arrest (1), mechanical ventilation (1), and altered mental status (1) at time of candidemia diagnosis. 
#Other Candida species in HIV-seronegative participants (Candida parapsilosis, n = 112; Candida glabrata, n = 84; Candida auris, n = 27; Candida tropicalis, n = 22; Candida krusei, n = 20; other species, n = 71) and HIV-seropositive participants (C. parapsilosis, n = 51; C. glabrata, n = 49; C. tropicalis, n = 20; C. auris, n = 8; C. krusei, n = 8; other species, n = 49). 
**By Fisher exact test. 
††Resistance was defined based on 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.

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