Roberto Luzzati1, Maria Merelli2, Filippo Ansaldi3, Chiara Rosin4, Annamaria Azzini5, Silvia Cavinato6, Pierluigi Brugnaro7, Claudio Vedovelli8, Annamaria Cattelan6, Busetti Marina9, Giuseppe Gatti10, Ercole Concia5, Matteo Bassetti2. 1. Infectious Disease Unit, University Hospital of Trieste, Piazzale dell' Ospitale 2, 34125, Trieste, Italy. roberto.luzzati@asuits.sanita.fvg.it. 2. Infectious Diseases Division, Santa Maria Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, 33010, Udine, Italy. 3. Department of Health Sciences, IRCCS San Martino IST, Largo R. Benzi 10, 16132, Genoa, Italy. 4. Infectious Disease Unit, University Hospital of Trieste, Piazzale dell' Ospitale 2, 34125, Trieste, Italy. 5. Infectious Diseases Division, University Hospital, Piazzale L. Scuro 10, 37134, Verona, Italy. 6. Infectious and Tropical Diseases Division, University Hospital, Via N. Giustiniani 2, 35128, Padua, Italy. 7. Infectious Diseases Division, Hospital of Venice, Castello 6777, 30122, Venice, Italy. 8. Infectious Diseases Division, Hospital of Bolzano, Via L. Bohler 5, 39100, Bolzano, Italy. 9. Laboratory for Microbiology, University Hospital, Strada di Fiume 447, 34149, Trieste, Italy. 10. Division of Cardiac Surgery, University Hospital, Via P. Valdoni 7, 34148, Trieste, Italy.
Abstract
PURPOSE: Risk factors for nosocomial candidemia, severity of sepsis, treatment, and outcome were compared between patients admitted to medicine wards and those to surgical and intensive care units (ICUs). METHODS: Data were retrospectively collected from patients belonging to six referral hospitals in Italy between January 2011 and December 2013. Risk factors for 30-day mortality were evaluated in the whole patient population. RESULTS: A total of 686 patients (mean age 70 ± 15 years) with candidemia were included. 367 (53.5 %) patients were in medicine wards, and 319 in surgery and ICUs. Host-related risk factors for candidemia were more common in medicine patients whereas healthcare-related factors in surgery/ICU patients. These patients showed severe sepsis and septic shock more commonly (71.7 %) than medicine patients (59.9 %) (p 0.003). The latter underwent central venous catheter (CVC) removal and adequate antifungal therapy less frequently than surgery/ICU patients. 149 (40.6 %) patients died with candidemia in medicine wards and 69 (21.6 %) in other wards (p < 0.001). Overall, the 30-day mortality was 36.3 %. At multivariate analysis, independent risk factors for death were aging, higher Charlson score, severe sepsis and septic shock, and no antifungal therapy, while major surgery and CVC removal were associated with higher probability of survival. CONCLUSIONS: The burden of risk factors for candidemia was different between medicine patients and those in other wards. Despite the lower severity of candidemia in medicine patients, their mortality turned out to be higher than in surgery or ICU patients. Awareness of the best management of candidemia should be pursued, especially in medicine wards.
PURPOSE: Risk factors for nosocomial candidemia, severity of sepsis, treatment, and outcome were compared between patients admitted to medicine wards and those to surgical and intensive care units (ICUs). METHODS: Data were retrospectively collected from patients belonging to six referral hospitals in Italy between January 2011 and December 2013. Risk factors for 30-day mortality were evaluated in the whole patient population. RESULTS: A total of 686 patients (mean age 70 ± 15 years) with candidemia were included. 367 (53.5 %) patients were in medicine wards, and 319 in surgery and ICUs. Host-related risk factors for candidemia were more common in medicine patients whereas healthcare-related factors in surgery/ICU patients. These patients showed severe sepsis and septic shock more commonly (71.7 %) than medicine patients (59.9 %) (p 0.003). The latter underwent central venous catheter (CVC) removal and adequate antifungal therapy less frequently than surgery/ICU patients. 149 (40.6 %) patients died with candidemia in medicine wards and 69 (21.6 %) in other wards (p < 0.001). Overall, the 30-day mortality was 36.3 %. At multivariate analysis, independent risk factors for death were aging, higher Charlson score, severe sepsis and septic shock, and no antifungal therapy, while major surgery and CVC removal were associated with higher probability of survival. CONCLUSIONS: The burden of risk factors for candidemia was different between medicine patients and those in other wards. Despite the lower severity of candidemia in medicine patients, their mortality turned out to be higher than in surgery or ICU patients. Awareness of the best management of candidemia should be pursued, especially in medicine wards.
Entities:
Keywords:
Candidemia; Elderly; Epidemiology; Medicine wards; Mortality; Risk factors
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