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Nosocomial candidemia in patients admitted to medicine wards compared to other wards: a multicentre study
Roberto Luzzati1, Maria Merelli2, Filippo Ansaldi3
1Infectious Disease Unit, University Hospital of Trieste, Piazzale dell' Ospitale 2, 34125, Trieste, Italy. roberto.luzzati@asuits.sanita.fvg.it.
Purpose:
Risk factors for nosocomial candidemia, severity of sepsis, treatment, and outcome were compared between patients admitted to medicine wards and those to surgical and intensive care units (ICUs).
Methods:
Data were retrospectively collected from patients belonging to six referral hospitals in Italy between January 2011 and December 2013. Risk factors for 30-day mortality were evaluated in the whole patient population.
Results:
A total of 686 patients (mean age 70 ± 15 years) with candidemia were included. 367 (53.5 %) patients were in medicine wards, and 319 in surgery and ICUs. Host-related risk factors for candidemia were more common in medicine patients whereas healthcare-related factors in surgery/ICU patients. These patients showed severe sepsis and septic shock more commonly (71.7 %) than medicine patients (59.9 %) (p 0.003). The latter underwent central venous catheter (CVC) removal and adequate antifungal therapy less frequently than surgery/ICU patients. 149 (40.6 %) patients died with candidemia in medicine wards and 69 (21.6 %) in other wards (p < 0.001). Overall, the 30-day mortality was 36.3 %. At multivariate analysis, independent risk factors for death were aging, higher Charlson score, severe sepsis and septic shock, and no antifungal therapy, while major surgery and CVC removal were associated with higher probability of survival.
Conclusions:
The burden of risk factors for candidemia was different between medicine patients and those in other wards. Despite the lower severity of candidemia in medicine patients, their mortality turned out to be higher than in surgery or ICU patients. Awareness of the best management of candidemia should be pursued, especially in medicine wards.
Insights
Nosocomial candidemia risk factors and outcomes differ between medicine and ICU/surgical wards. Medicine patients had higher mortality despite less severe infections, highlighting a need for improved management strategies.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Nosocomial candidemia is a significant cause of bloodstream infections in hospitalized patients.
- Understanding risk factors and outcomes across different hospital settings is crucial for effective management.
- Previous studies have not fully elucidated the differences in candidemia epidemiology and outcomes between general medicine wards and intensive care units (ICUs) or surgical settings.
Purpose of the Study:
- To compare risk factors, severity of sepsis, treatment, and outcomes of nosocomial candidemia in patients admitted to medicine wards versus surgical and intensive care units (ICUs).
- To identify independent risk factors associated with 30-day mortality in patients with candidemia.
Main Methods:
- Retrospective data collection from six Italian referral hospitals between January 2011 and December 2013.
- Inclusion of 686 patients diagnosed with candidemia.
- Multivariate analysis to evaluate risk factors for 30-day mortality.
Main Results:
- Host-related risk factors for candidemia were more prevalent in medicine patients, while healthcare-related factors were more common in surgery/ICU patients.
- Surgery/ICU patients experienced severe sepsis and septic shock more frequently (71.7%) than medicine patients (59.9%).
- Medicine patients had higher 30-day mortality (40.6%) compared to surgery/ICU patients (21.6%), despite less severe initial infections.
Conclusions:
- Significant differences exist in the burden of risk factors for candidemia between medicine and surgery/ICU patients.
- Higher mortality in medicine patients suggests a need for optimized management strategies in these wards.
- Independent risk factors for death included advanced age, higher Charlson score, severe sepsis, and lack of antifungal therapy.
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