Carlo Tascini1, Marco Falcone2, Matteo Bassetti3, Francesco G De Rosa4, Emanuela Sozio5, Alessandro Russo2, Francesco Sbrana6, Andrea Ripoli6, Maria Merelli3, Claudio Scarparo3, Franco Carmassi5, Mario Venditti2, Francesco Menichetti7. 1. Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy. 2. Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy. 3. Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy. 4. Department of Medical Sciences, University of Turin, Italy; Infectious Diseases, Amedeo di Savoia Hospital, Turin, Italy. 5. Emergency Medicine Unit, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy. 6. Fondazione Toscana Gabriele Monasterio, Pisa, Italy. 7. Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy. Electronic address: menichettifrancesco@gmail.com.
Abstract
BACKGROUND: An increasing number of candidemia episodes has been reported in patients cared for in internal medicine wards. These usually older and frail patients may not be suspected as having candidemia because they lack fever at the onset of the episode. To identify the risk factors associated with the lack of fever at the onset of candidemia (ie, the collection of the first positive blood culture for Candida spp.) in patients cared for in internal medicine wards, we compared 2 group of patients with or without fever. METHODS: We retrospectively review data charts from 3 tertiary care, university hospitals in Italy, comparing patients with or without fever at onset of candidemia. Consecutive candidemic episodes in afebrile patients and matched febrile controls were identified during the 3-year study period. Patient baseline characteristics and several infection-related variables were examined. Random forest analysis was used, given the number of predictors to be considered and the potential complexity of their relations with the onset of fever. RESULTS: We identified 147 candidemic episodes without fever at onset and 147 febrile candidemia episodes. Factors associated with the lack of fever at onset of candidemia were diabetes, Clostridium difficile infection, and a shorter delta time from internal medicine wards admission to the onset of candidemia. The only variable associated with fever was the use of intravascular devices. Quite unexpectedly, antifungal therapy was administered more frequently to patients without fever, and no differences on 30-day mortality rate were documented in the 2 study groups. CONCLUSIONS: Clinicians should be aware that an increasing number of patients with invasive candidiasis cared for in internal medicine wards may lack fever at onset, especially those with diabetes and C. difficile infection. Candidemia should be suspected in patients with afebrile systemic inflammatory response syndrome or in worsening clinical condition: blood cultures should be taken, and a timely and appropriate antifungal therapy should be considered.
BACKGROUND: An increasing number of candidemia episodes has been reported in patients cared for in internal medicine wards. These usually older and frail patients may not be suspected as having candidemia because they lack fever at the onset of the episode. To identify the risk factors associated with the lack of fever at the onset of candidemia (ie, the collection of the first positive blood culture for Candida spp.) in patients cared for in internal medicine wards, we compared 2 group of patients with or without fever. METHODS: We retrospectively review data charts from 3 tertiary care, university hospitals in Italy, comparing patients with or without fever at onset of candidemia. Consecutive candidemic episodes in afebrile patients and matched febrile controls were identified during the 3-year study period. Patient baseline characteristics and several infection-related variables were examined. Random forest analysis was used, given the number of predictors to be considered and the potential complexity of their relations with the onset of fever. RESULTS: We identified 147 candidemic episodes without fever at onset and 147 febrile candidemia episodes. Factors associated with the lack of fever at onset of candidemia were diabetes, Clostridium difficileinfection, and a shorter delta time from internal medicine wards admission to the onset of candidemia. The only variable associated with fever was the use of intravascular devices. Quite unexpectedly, antifungal therapy was administered more frequently to patients without fever, and no differences on 30-day mortality rate were documented in the 2 study groups. CONCLUSIONS: Clinicians should be aware that an increasing number of patients with invasive candidiasis cared for in internal medicine wards may lack fever at onset, especially those with diabetes and C. difficile infection. Candidemia should be suspected in patients with afebrile systemic inflammatory response syndrome or in worsening clinical condition: blood cultures should be taken, and a timely and appropriate antifungal therapy should be considered.
Authors: Francesco Sbrana; Emanuela Sozio; Matteo Bassetti; Andrea Ripoli; Filippo Pieralli; Anna Maria Azzini; Alessandro Morettini; Carlo Nozzoli; Maria Merelli; Sebastiano Rizzardo; Giacomo Bertolino; Davide Carrara; Claudio Scarparo; Ercole Concia; Francesco Menichetti; Carlo Tascini Journal: Intern Emerg Med Date: 2018-01-10 Impact factor: 3.397
Authors: Marco Falcone; Giusy Tiseo; Belen Gutiérrez-Gutiérrez; Giammarco Raponi; Paolo Carfagna; Chiara Rosin; Roberto Luzzati; Diego Delle Rose; Massimo Andreoni; Alessio Farcomeni; Mario Venditti; Jesus Rodríguez-Baño; Francesco Menichetti Journal: Open Forum Infect Dis Date: 2019-07-16 Impact factor: 3.835