Background This study quantifies the mortality attributable to Candida bloodstream infections (BSI) in the modern era of echinocandins. Methods We conducted a retrospective cohort study of adult patients admitted to Barnes Jewish Hospital, a 1368-bed tertiary care academic hospital, in Saint Louis, Missouri, from 1 February 2012 to 30 April 2019. We identified 626 adult patients with Candida BSI that were frequency-matched with 6269 control patients that had similar Candida BSI risk-factors. The 90-day all-cause mortality attributable to Candida BSI was calculated using three methods—propensity score matching, matching by inverse weighting of propensity score, and stratified analysis by quintile. Results The 90-day crude mortality was 42.4% (269 patients) for Candida BSI cases and 17.1% (1083 patients) for frequency-matched controls. Following propensity score-matching, the attributable risk difference for 90-day mortality was 28.4% with hazard ratio (HR) of 2.12 (95% confidence interval [CI], 1.98–2.25, P < .001). In the stratified analysis, the risk for mortality at 90 days was highest in patients in the lowest risk quintile to develop Candida BSI (hazard ratio [HR] 3.13 (95% CI, 2.33–4.19). Patients in this lowest risk quintile accounted for 81(61%) of the 130 untreated patients with Candida BSI. Sixty-nine percent of untreated patients (57/83) died versus 35% of (49/127) of treated patients (P < .001). Conclusions Patients with Candida BSI continue to experience high mortality. Mortality attributable to Candida BSI was more pronounced in patients at lowest risk to develop Candida BSI. A higher proportion of these low-risk patients went untreated, experienced higher mortality, and should be the target of aggressive interventions to ensure timely, effective treatment.

中文翻译：

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现代念珠菌血流感染的归因死亡率：倾向评分分析

背景 本研究量化了现代棘白菌素时代念珠菌血流感染 (BSI) 导致的死亡率。方法 我们对 2012 年 2 月 1 日至 2019 年 4 月 30 日在密苏里州圣路易斯市拥有 1368 个床位的三级护理学术医院巴恩斯犹太医院收治的成年患者进行了一项回顾性队列研究。我们确定了 626 名患有念珠菌 BSI 的成年患者与具有相似念珠菌 BSI 风险因素的 6269 名对照患者进行频率匹配。使用三种方法计算归因于念珠菌 BSI 的 90 天全因死亡率——倾向得分匹配、倾向得分反加权匹配和五分位数分层分析。结果 念珠菌 BSI 病例的 90 天粗死亡率为 42.4%（269 名患者），频率匹配对照组为 17.1%（1083 名患者）。倾向评分匹配后，90 天死亡率的归因风险差异为 28.4%，风险比 (HR) 为 2.12（95% 置信区间 [CI]，1.98–2.25，P < .001）。在分层分析中，发生念珠菌 BSI 风险最低的五分之一患者的 90 天死亡率风险最高（风险比 [HR] 3.13（95% CI，2.33-4.19）。这个风险最低的五分之一患者占130 名未经治疗的念珠菌 BSI 患者中有 81 名 (61%)。69% 的未治疗患者 (57/83) 死亡，而接受治疗的患者中有 35% (49/127) 死亡 (P < .001)。结论念珠菌 BSI 继续经历高死亡率。念珠菌 BSI 导致的死亡率在发展为念珠菌 BSI 的风险最低的患者中更为明显。这些低风险患者中有更高比例未接受治疗，