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).
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.
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.
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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Bitar D, Lortholary O, Le Strat Y, Nicolau J, Coignard B, Tattevin P, Che D, Dromer F. Population-based analysis of invasive fungal infections, France, 2001–2010. Emerg Infect Dis. 2014;20:1149–55.
Wisplinghoff H, Ebbers J, Geurt J, et al. Nosocomial bloodstream infections due to Candida spp. in the USA: species distribution, clinical features and antifungal susceptibilities. Int J Antimicrob Agents. 2014;43:78–81.
Horn DL, Neofytos D, Anaissie EJ, et al. Epidemiology and outcomes of candidemia in 2019 patients: data from the prospective antifungal therapy alliance registry. Clin Infect Dis. 2009;48:1695–703.
Bassetti M, Molinari MP, Mussap M, Viscoli C, Righi E. Candidemia in internal medicine departments: the burden of a rising problem. Clin Microb Infect. 2013;19:E281–4.
Luzzati R, Cavinato S, Deiana ML, Rosin C, Maurel C, Borelli M. Epidemiology and outcome of nosocomial candidemia in elderly patients admitted prevalently in medical wards. Aging Clin Exp Res. 2015;27:131–7.
De Rosa FG, Corcione S, Filippini S, et al. The effect on mortality of fluconazole or echinocandins treatment in candidemia in internal medicine wards. PLoS One. 2015;10:e0125149.
Nieto MC, Telleria O, Cisterna R. Sentinel surveillance of invasive candidiasis in Spain: epidemiology and antifungal susceptibility. Diagn Microbiol Infect Dis. 2015;81:34–40.
Lortholary O, Ranaudat C, Sitbon K, et al. Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002–2010). Intensive Care Med. 2014;40:1303–12.
Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microb Rev. 2007;20:133–63.
European Committee on Antimicrobial Susceptibility Test. Antimicrobials for Candida infections-EUCAST clinical MIC breakpoints. 2013;2013-03-11 (v 6.1).
Bone RC, Balk RA, Cerra FB, et al. Definition for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. ACCP/SCCM Consensus Conference Committee. American College of Chest Physician/Society of Critical Care Medicine. Chest. 1992;101:1644–55.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.
Swets JA. Measuring the accuracy of diagnostic system. Science. 1988;240:1285–93.
Guimaraes T, Nucci M, Mendonca JS, et al. Epidemiology and predictors of a poor outcome in elderly patients with candidemia. Int J Infect Dis. 2012;16:e442–7.
Wang H, Liu N, Yin M, et al. The epidemiology, antifungal use and risk factors of death in elderly patients with candidemia: a multicentre retrospective study. BMC Infect Dis. 2014;14:609.
Eggimann P, Garbino J, Pittet D. Epidemiology of Candida species infections in critically ill non-immunosuppressed patients. Lancet Infect Dis. 2003;3:685–702.
Bassetti M, Merelli M, Righi E, et al. Epidemiology, species distribution, antifungal susceptibility, and outcome of candidemia across five sites in Italy and Spain. J Clin Microb. 2013;51:4167–72.
De Rosa GF, Trecarichi EM, Montrucchio C, et al. Mortality in patients with early- and late-onset candidaemia. J Antimicrob Chemother. 2013;68:927–35.
Castle SC, Uyemura K, Fulop T, Mafinodan T. Host resistance and immune responses in advanced age. Clin Geriatr. 2007;23:463–79.
Guinea J. Global trends in the distribution of Candida species causing candidemia. Clin Microbiol Infect. 2014;20:5–10.
Pfaller MA, Diekema DJ. Role of sentinel surveillance of candidemia: trends in species distribution and antifungal susceptibility. J Clin Microbiol. 2002;40:3551–7.
Pfaller MA, Diekema DJ, Jones RN, Messer SA, Hollis RJ. Trends in antifungal susceptibility of Candida spp. isolated from pediatric and adult patients with bloodstream infections: sentry antimicrobial surveillance program, 1997 to 2000. J Clin Microbiol. 2002;40:852–6.
Pfaller MA, Boyken L, Hollis RJ, et al. Comparison of results of fluconazole and voriconazole disk diffusion testing for Candida spp. with results from a central reference laboratory in the ARTEMIS DISK Global Antifungal Surveillance Program. Diagn Microbiol Infect Dis. 2009;25:27–34.
Messer SA, Moet GJ, Kirby JT, Jones RN. Activity of contemporary antifungal agents, including the novel echinocandin anidulafungin, tested against Candida spp., Cryptococcus spp., and Aspergillus spp.: report from the SENTRY Antimicrobial Surveillance Program (2006 to 2007). J Clin Microbiol. 2009;47:1942–6.
Luzzati R, Cavinato S, Giangreco M, et al. Peripheral and total parenteral nutrition as the strongest risk factors for nosocomial candidemia in elderly patients: a matched case–control study. Mycoses. 2013;56:664–71.
Tascini C, Sozio S, Tintori C, et al. Peripherally inserted central catheter as a predominant risk factor for candidemia in critically ill patients in internal medicine wards in Italy. Intensive Care Med. 2015;41:1498–9.
Puig-Asensio M, Padilla B, Garnacho-Montero J, et al. Epidemiology a predictive factors for early and late mortality in Candida bloodstream infections: a population-based surveillance in Spain. Clin Microbiol Infect. 2014;20:O245–54.
Pappas PG, Kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48:503–35.
Cornely OA, Bassetti M, Calandra T, ESCMID Fungal Infection Study Group. ESCMID guideline for the diagnosis and management of Candida diseases non-neutropenic adult patients. Clin Microb Infect. 2012;18:19–37.
Scudeller L, Viscoli C, Menichetti F, et al. An Italian consensus for invasive candidiasis management (ITALIC). Infection. 2014;42:263–79.
Andes DR, Safdar N, Baddley JW, et al. Impact of treatment strategy on outcomes in patients with candidemia and other form of invasive candidiasis: a patient-level quantitative review of randomized trials. Clin Infect Dis. 2012;54:1110–22.
Bassetti M, Righi E, Ansaldi F, et al. A multicenter study of septic shock due to candidemia: outcomes and predictors of mortality. Intensive Care Med. 2014;40:839–45.
Murri R, Scoppettuolo G, Ventura G, et al. Initial antifungal strategy does not correlate with mortality in patients with candide mia. Eur J Clin Microb. 2015;35:187–93.
Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Sociey of America. Clin Infect Dis. 2016;62:e1–50.
The study was approved by the local institutional review board. Patient characteristics of each hospital participating to the study were anonymized prior to be reported in a common electronic database. For this type of study formal consent is not required in Italy. The study has been performed in accordance with the ethical standards laid down in the 1964 declaration of Helsinki and its later amendments.
The authors declare no funding.
Conflict of interest
The authors declare that they have no conflicts of interest.
About this article
Cite this article
Luzzati, R., Merelli, M., Ansaldi, F. et al. Nosocomial candidemia in patients admitted to medicine wards compared to other wards: a multicentre study. Infection 44, 747–755 (2016). https://doi.org/10.1007/s15010-016-0924-9
- Risk factors
- Medicine wards