Attributable mortality of candidemia: a systematic review of matched cohort and case-control studies

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Abstract
A systematic review of matched cohort and case-control studies was performed to examine the mortality attributable to candidemia. The review included studies that compared mortality of patients with candidemia (cases) to that of matched patients without candidemia (controls). Secondary variables examined were the length and cost of hospital stay. Relevant studies were identified using the PubMed database and by examining the references of the initially selected studies. Two independent reviewers performed the literature search, study selection and data extraction from the identified studies. A total of seven studies were included in the review. The patients included those hospitalized in intensive care units (ICU) and hospital wards and those undergoing transplantation. The mortality attributed to candidemia in the reviewed studies ranged from 5 to 71%. For six of the reviewed studies the difference in mortality between cases and controls was statistically significant. Among those who survived, the length of stay and the cost of hospitalization of patients with candidemia were significantly higher than those of controls. Despite the methodological heterogeneity of the reviewed studies, the data from the available matched cohort and case-control studies suggest that candidemia is associated with considerable mortality that is attributed, at least to some degree, to the infection itself and not only to the presence of another comorbidity.