Factors associated with increased mortality identified on multivariate analysis:
(1) increasing delay before initiating antifungal therapy (lowest mortality if drug started on day of symptom onset)
(2) higher APACHE II score
Factors associated with delay in appropriate therapy:
(1) delay in responding to the signs and symptoms
(2) waiting for a positive culture before starting therapy
(3) waiting for susceptibility testing results
(4) administering an antifungal agent to which the isolate is resistant (see below)
(5) assuming that symptoms are due to another organism
Additional factors associated with increased mortality (Table 2, page 29):
(1) hospitalized in the ICU at the time of symptom onset (related to a higher APACHE II score)
(2) mechanical ventilation
(3) corticosteroid therapy
Other factors affecting therapy (pages 25 and page 26):
(1) inappropriate choice of antifungal agent for empiric therapy
(2) inadequate dose
(3) administration of an antifungal agent to which the isolate is resistant
Antifungal therapy should be started empirically in any patient with a high risk for candidemia as soon as possible after symptom onset.
