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Epidemiology and outcome of candidemia in internal medicine wards: A regional study in Italy

Published:August 20, 2016DOI:https://doi.org/10.1016/j.ejim.2016.08.020

      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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