Highlights
- •Candidemia in Internal Medicine Wards (IMWs) is frequent and has high mortality.
- •Worrisome rates of inappropriate management of candidemia were found in IMWs.
- •Prompt initiation of antifungals and CVC removal were associated to lower mortality.
- •There is an urgent need to increase the awareness of IMWs toward candidemia.
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 <24 h, 24–72 h, and >72 h 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 72 h 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.
Keywords
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Article info
Publication history
Published online: August 20, 2016
Accepted:
August 10,
2016
Received in revised form:
July 13,
2016
Received:
May 20,
2016
Identification
Copyright
© 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
