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Clinical characteristics, management and outcome of patients with invasive candidiasis hospitalized in Internal Medicine Units: findings from a registry by the Italian Scientific Society FADOI

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Abstract

Purpose

Invasive candidiasis (IC) is a challenging clinical condition, burdened by relevant mortality and morbidity. There is limited knowledge on the occurrence and management of IC in Internal Medicine Units (IMUs). Aim of this study was to provide real-world data on this topic.

Methods

Consecutive objectively diagnosed cases of IC were collected in this prospective registry, which involved 18 IMUs in Italy. Patients were followed-up to 90 days from the diagnosis of candidemia.

Results

A total of 111 patients were observed (median age 78, IQR 67–83) for an overall incidence of infection of 1.89 cases/1000 hospital admissions. Candida albicans was the most frequent isolated species (62%), followed by Candida parapsilosis (17%) and Candida glabrata (13%). Echinocandins and fluconazole were used as initial therapy in 56.8 and 43.2% of patients, respectively. Antifungal therapy was started within 24 h in 18.9% of patients, in 40.6% in the period 1–3 days, and in 40.5% of patients more than 3 days after blood cultures. Death rate was 19.8% at 30 days and 40.5% at 90 days. At multivariable analysis concomitant bacteremia (i.e. polymicrobial sepsis), and fluconazole as the initial therapy were associated with an increased risk of death at 90 days.

Conclusions

The incidence of IC is not negligible, and our registry confirmed that these patients have a relevant mortality rate at 90 days. Concomitant bacteremia, featuring polymicrobial sepsis, and starting antifungal treatment with fluconazole instead of echinocandins independently increase the risk of death. Efforts are needed to improve the awareness and management of IC in IMUs.

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Author information

Authors and Affiliations

  1. Internal Medicine Department, Careggi Hospital, Florence, Italy

    F. Pieralli

  2. Internal Medicine Department, Insubria University, Varese, Italy

    F. Dentali

  3. Internal Medicine Department, San Giovanni Bosco Hospital, Turin, Italy

    M. Giusti

  4. Internal Medicine Department, Veneziale Hospital, Isernia, Italy

    T. Ciarambino

  5. Internal Medicine Department, Ospedale Civile Di Legnano (Milan), Legnano, Italy

    A. Mazzone

  6. Department of Infectious Diseases, University of Verona, Verona, Italy

    E. Concia

  7. Department of Laboratory Sciences & Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy

    M. Sanguinetti

  8. Internal Medicine Department, Regina Montis Regalis Hospital, Mondovì, CN, Italy

    M. G. Nallino

  9. Internal Medicine Department, Garibaldi Hospital, Catania, Italy

    I. Morana

  10. Internal Medicine Department, Vannini Hospital, Rome, Italy

    C. Santini

  11. FADOI Study Center, Milano, Italy

    G. Gussoni & E. Zagarrì

  12. Internal Medicine Department, AFaR Division, Fatebenefratelli Foundation, San Giovanni Calibita Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy

    D Manfellotto

Authors
  1. F. Pieralli
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  2. F. Dentali
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  3. M. Giusti
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  5. A. Mazzone
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  6. E. Concia
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  8. M. G. Nallino
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  9. I. Morana
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  12. E. Zagarrì
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  13. D Manfellotto
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Consortia

FADOI—IFI Registry Group

  • F. Pieralli
  • , E. Antonielli
  • , T. Ciarambino
  • , A. Mazzone
  • , L. Marchionni
  • , M. G. Nallino
  • , S. Ariaudo
  • , V. Benedetti
  • , I. Morana
  • , C. Sgroi
  • , C. Santini
  • , E. Pistella
  • , A. Belfiore
  • , A. Tedesco
  • , D. Carrara
  • , E. Magnani
  • , F. Landini
  • , M. Giusti
  • , P. Colagrande
  • , R. Gerloni
  • , G. Balbi
  • , M. Gino
  • , E. Limido
  •  & C. Norbiato

Corresponding author

Correspondence to E. Zagarrì.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest. All authors declare that the submitted work has not been published before (neither in English nor in any other language) and that the work is not under consideration for publication elsewhere.

Ethical standards

This Registry has been approved by the appropriate ethics committee and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Specific Italian laws have been observed, too.

Appendix

Appendix

List of the Members of the FADOI—IFI-C Registry Group: F. Pieralli, E. Antonielli, (Careggi Hospital, Florence); T. Ciarambino (Veneziale Hospital, Isernia), A. Mazzone, L. Marchionni (Ospedale Civile di Legnano -MI); M.G. Nallino, S. Ariaudo, V. Benedetti (Regina Montis Regalis Hospital, Mondovì-CN); I. Morana, C. Sgroi (Garibaldi Hospital, Catania); C. Santini, E. Pistella (Vannini Hospital, Rome); A. Belfiore (Policlinico di Bari); A. Tedesco (San Bonifacio Hospital – VR); D. Carrara (Ospedale Unico della Versilia, Lucca); E. Magnani (Bufalini Hospital, Cesena); F. Landini (Parma Hospital); M. Giusti, P. Colagrande (San Giovanni Bosco Hospital, Turin); R. Gerloni (Cattinara Hospital, Trieste); G. Balbi (S. Bortolo Hospital, Vicenza); M. Gino (Ospedale di Rivoli, Turin); E. Limido (Sant'Anna Hospital, Como); C. Norbiato (A.O. Ordine Mauriziano, Turin).

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Pieralli, F., Dentali, F., Giusti, M. et al. Clinical characteristics, management and outcome of patients with invasive candidiasis hospitalized in Internal Medicine Units: findings from a registry by the Italian Scientific Society FADOI. Infection 49, 277–285 (2021). https://doi.org/10.1007/s15010-020-01535-z

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