Sara Tedeschi1, Fabio Tumietto2, Maddalena Giannella2, Michele Bartoletti2, Francesco Cristini2, Giorgio Cioni3, Simone Ambretti4, Edoardo Carretto5, Vittorio Sambri6, Mario Sarti7, Pierluigi Viale2. 1. Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy. Electronic address: sara.tedeschi@aosp.bo.it. 2. Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy. 3. Internal Medicine Unit, Hospital of Pavullo nel Frignano, Modena, Italy. 4. Clinical Microbiology Unit, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy. 5. Microbiology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. 6. Microbiology Unit, Hub Laboratory AUSL della Romagna, Pievesestina, Forlì-Cesena, Italy. 7. Clinical Microbiology Unit, S. Agostino-Estense Hospital, Baggiovara, Modena, Italy.
Abstract
BACKGROUND: More than one-third of candidemia episodes occur in Internal Medicine Wards (IMWs) but only few studies have focused on this setting and specific data about epidemiology, clinical characteristics and risk factors for mortality are scant. OBJECTIVE: To describe epidemiology and to assess risk factors for in-hospital mortality among patients with candidemia in IMWs. METHODS: Multicenter retrospective cohort study on patients with candidemia cared for in IMWs of an Italian region (Emilia Romagna) from January 2012 to December 2013. Non survivors were compared with survivors; variables with p≤0.1 at univariate analysis were entered into a multivariate Cox regression model. RESULTS: 232 patients were included. Overall candidemia incidence was 2.2 cases/1000 admissions. Candida albicans accounted for 59% of cases. Antifungal treatment was started <24h, 24-72h, and >72h from blood cultures in 47%, 27% and 12% of patients, respectively; 13.8% of patients received no antifungal treatment. In-hospital mortality was 40%. At multivariate analysis, chronic-obstructive-pulmonary-disease (HR 2.72, 95%CI 1.66-4.45, p<0.001) and isolation of C. tropicalis (HR 2.18, 95%CI 1.19-3.99, p=0.01) were the independent risk factors for in-hospital mortality; central-venous-catheter removal (HR 0.59, 95%CI 0.36-0.96, p=0.03) and adequate and timely (within 72h from blood drawing) empirical therapy (HR 0.42, 95%CI 0.25-0.69, p=0.001) were protective factors. CONCLUSIONS: The present study conducted in a relatively large geographic area confirms high incidence and mortality of candidemia in IMWs, with a worrisome rate of inappropriateness in patient management. Specific interventions aimed to increase awareness of IMWs about candidemia are needed.
BACKGROUND: More than one-third of candidemia episodes occur in Internal Medicine Wards (IMWs) but only few studies have focused on this setting and specific data about epidemiology, clinical characteristics and risk factors for mortality are scant. OBJECTIVE: To describe epidemiology and to assess risk factors for in-hospital mortality among patients with candidemia in IMWs. METHODS: Multicenter retrospective cohort study on patients with candidemia cared for in IMWs of an Italian region (Emilia Romagna) from January 2012 to December 2013. Non survivors were compared with survivors; variables with p≤0.1 at univariate analysis were entered into a multivariate Cox regression model. RESULTS: 232 patients were included. Overall candidemia incidence was 2.2 cases/1000 admissions. Candida albicans accounted for 59% of cases. Antifungal treatment was started <24h, 24-72h, and >72h from blood cultures in 47%, 27% and 12% of patients, respectively; 13.8% of patients received no antifungal treatment. In-hospital mortality was 40%. At multivariate analysis, chronic-obstructive-pulmonary-disease (HR 2.72, 95%CI 1.66-4.45, p<0.001) and isolation of C. tropicalis (HR 2.18, 95%CI 1.19-3.99, p=0.01) were the independent risk factors for in-hospital mortality; central-venous-catheter removal (HR 0.59, 95%CI 0.36-0.96, p=0.03) and adequate and timely (within 72h from blood drawing) empirical therapy (HR 0.42, 95%CI 0.25-0.69, p=0.001) were protective factors. CONCLUSIONS: The present study conducted in a relatively large geographic area confirms high incidence and mortality of candidemia in IMWs, with a worrisome rate of inappropriateness in patient management. Specific interventions aimed to increase awareness of IMWs about candidemia are needed.
Authors: Renáta Tóth; Jozef Nosek; Héctor M Mora-Montes; Toni Gabaldon; Joseph M Bliss; Joshua D Nosanchuk; Siobhán A Turner; Geraldine Butler; Csaba Vágvölgyi; Attila Gácser Journal: Clin Microbiol Rev Date: 2019-02-27 Impact factor: 26.132