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

Sara Tedeschi, Fabio Tumietto, Maddalena Giannella, Michele Bartoletti, Francesco Cristini, Giorgio Cioni, Simone Ambretti, Edoardo Carretto, Vittorio Sambri, Mario Sarti, Pierluigi Viale

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)39-44
Number of pages6
JournalEuropean Journal of Internal Medicine
Volume34
DOIs
Publication statusPublished - Oct 1 2016

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Candidemia
Internal Medicine
Italy
Epidemiology
Hospital Mortality
Survivors
Central Venous Catheters
Mortality
Incidence
Candida albicans
Proportional Hazards Models
Chronic Obstructive Pulmonary Disease
Cohort Studies
Therapeutics
Multivariate Analysis
Retrospective Studies

Keywords

  • Antifungal treatment
  • Candidemia
  • Epidemiology
  • Internal medicine wards
  • Mortality

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Tedeschi, S., Tumietto, F., Giannella, M., Bartoletti, M., Cristini, F., Cioni, G., ... Viale, P. (2016). Epidemiology and outcome of candidemia in internal medicine wards: A regional study in Italy. European Journal of Internal Medicine, 34, 39-44. https://doi.org/10.1016/j.ejim.2016.08.020

Epidemiology and outcome of candidemia in internal medicine wards : A regional study in Italy. / Tedeschi, Sara; Tumietto, Fabio; Giannella, Maddalena; Bartoletti, Michele; Cristini, Francesco; Cioni, Giorgio; Ambretti, Simone; Carretto, Edoardo; Sambri, Vittorio; Sarti, Mario; Viale, Pierluigi.

In: European Journal of Internal Medicine, Vol. 34, 01.10.2016, p. 39-44.

Research output: Contribution to journalArticle

Tedeschi, S, Tumietto, F, Giannella, M, Bartoletti, M, Cristini, F, Cioni, G, Ambretti, S, Carretto, E, Sambri, V, Sarti, M & Viale, P 2016, 'Epidemiology and outcome of candidemia in internal medicine wards: A regional study in Italy', European Journal of Internal Medicine, vol. 34, pp. 39-44. https://doi.org/10.1016/j.ejim.2016.08.020
Tedeschi, Sara ; Tumietto, Fabio ; Giannella, Maddalena ; Bartoletti, Michele ; Cristini, Francesco ; Cioni, Giorgio ; Ambretti, Simone ; Carretto, Edoardo ; Sambri, Vittorio ; Sarti, Mario ; Viale, Pierluigi. / Epidemiology and outcome of candidemia in internal medicine wards : A regional study in Italy. In: European Journal of Internal Medicine. 2016 ; Vol. 34. pp. 39-44.
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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.",
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AU - Tedeschi, Sara

AU - Tumietto, Fabio

AU - Giannella, Maddalena

AU - Bartoletti, Michele

AU - Cristini, Francesco

AU - Cioni, Giorgio

AU - Ambretti, Simone

AU - Carretto, Edoardo

AU - Sambri, Vittorio

AU - Sarti, Mario

AU - Viale, Pierluigi

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N2 - 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.

AB - 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.

KW - Antifungal treatment

KW - Candidemia

KW - Epidemiology

KW - Internal medicine wards

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