A Clinicopathological Study of Candidemia in the Elderly

Abstract

Candidemias were reviewed in 22 elderly patients hospitalized in Yokufukai Geriatric Hospital. Their ages ranged from 62 to 101 years, with a mean age of 81 years. Sixteen patients had either old cerebrovascular disease or senile dementia. In seven patients, synchronous or metachronous bacteremia in the blood culture was as-sociated with the candidemia. Eighty-six percent of total candidemias were related to intravenous hyperalimen-tation (IVH). The mean duration from the start of IVH to candidemia was 46 days. Eleven patients (50%) devel-oped candidemia within one month after the beginning of IVH. Fourteen patients had the IVH catheters changed one or more times before the time of positive Candida in the blood culture. The mean duration from the start of IVH to candidemia was 59 days. Eight patients, on the other hand, had the catheters un-changed and the mean duration was 23 days. Ninety-six percent were receiving broad-spectrum antibiotic ther-apy at the time of the positive Candida in blood culture. Eight patients developed DIC. The overall mortality was 91% (twenty patients) and thirteen (65%) of them died within one month after the onset of candidemia. There was no difference in mortality when all candidemic patients received no anti-mycotic therapy were com-pared with the patients given any amount of miconazole or 5-FC. The causes of death for candidemic patients included fungemic shock (6 patients), hemorrhagic shock (4 patients), and shock associated with DIC (3 patients). From the results of this study, candidemia in the elderly was produced by various underlying diseases such as central nervous system diseases or pneumonia. In most patients, long-term antibiotic therapy and IVH were associated with an increased risk factor for can-didemia. The prognosis for candidemia was poor in the elderly. © 1990, The Japan Geriatrics Society. All rights reserved.