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

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. (C) 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.