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Klingspor HT, Hällgren A. Factors influencing outcomes in candidemia: A retrospective study of patients in a Swedish county. Mycoses 2024; 67:e13758. [PMID: 38932675 DOI: 10.1111/myc.13758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Candidemia is a diverse condition and associated with a broad spectrum of clinical presentation. As mortality is high, timely diagnosis of candidemia and start of correct therapeutic treatment are essential. OBJECTIVES To investigate characteristics and factors influencing outcomes for patients with candidemia in a Swedish setting. METHOD All positive blood cultures for any Candida species in Östergötland County from 2012 to 2016 were screened. Medical records of patients fulfilling all inclusion criteria and no exclusion criteria were retrospectively reviewed to obtain data on risk factors, diagnostic and therapeutic procedures and at what wards candidemia was diagnosed. Univariate logistic regression and multivariable regression analysis were used to obtain odds ratio to determine risk factors for 30-day all-cause mortality associated with candidemia. A p-value <.05 was considered statistically significant. RESULTS Of all analysed risk factors, increasing age, renal failure with haemodialysis, immunosuppressant treatment, and severity of the infection (i.e. if septic shock was present) were significantly associated with 30-day mortality in univariate analysis (p < .05). Removal of a central venous catheter or an infectious diseases consultant was associated with a significantly lower odds ratio for death at 30 days (p < .05). With multivariable analysis, age, time to start of treatment and infectious disease consultant remained significant (p < .05). CONCLUSION In conclusion, this study provides an update of the epidemiology and outcomes of candidemia in a Swedish setting, highlighting that patients with candidemia are present at various departments and indicates the importance of an infectious disease consultant when candidemia is present.
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Affiliation(s)
- Hanna Thorold Klingspor
- Department of Infectious Diseases in Östergötland and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anita Hällgren
- Department of Infectious Diseases in Östergötland and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Giacobbe DR, Marelli C, Mora S, Guastavino S, Russo C, Brucci G, Limongelli A, Vena A, Mikulska M, Tayefi M, Peluso S, Signori A, Di Biagio A, Marchese A, Campi C, Giacomini M, Bassetti M. Early diagnosis of candidemia with explainable machine learning on automatically extracted laboratory and microbiological data: results of the AUTO-CAND project. Ann Med 2023; 55:2285454. [PMID: 38010342 PMCID: PMC10836245 DOI: 10.1080/07853890.2023.2285454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Candidemia is associated with a heavy burden of morbidity and mortality in hospitalized patients. The availability of blood culture results could require up to 48-72 h after blood draw; thus, early treatment decisions are made in the absence of a definite diagnosis. METHODS In this retrospective study, we assessed the performance of different supervised machine learning algorithms for the early differential diagnosis of candidemia and bacteremia in adult patients on a large dataset automatically extracted within the AUTO-CAND project. RESULTS Overall, 12,483 episodes of candidemia (1275; 10%) or bacteremia (11,208; 90%) were included in the analysis. A random forest classifier achieved the best diagnostic performance for candidemia, with sensitivity 0.98 and specificity 0.65 on the training set (true skill statistic [TSS] = 0.63) and sensitivity 0.74 and specificity 0.57 on the test set (TSS = 0.31). Then, the random classifier was trained in the subgroup of patients with available serum β-D-glucan (BDG) and procalcitonin (PCT) values by exploiting the feature ranking learned in the entire dataset. Although no statistically significant differences were observed from the performance measures obtained by employing BDG and PCT alone, the performance measures of the classifier that included the features selected in the entire dataset, plus BDG and PCT, were the highest in most cases. CONCLUSIONS Random forest classifiers trained on large datasets of automatically extracted data have the potential to improve current diagnostic algorithms for candidemia. However, further development through implementation of automatically extracted clinical features may be necessary to achieve crucial improvements.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cristina Marelli
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | | | - Chiara Russo
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giorgia Brucci
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandro Limongelli
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Vena
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Malgorzata Mikulska
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maryam Tayefi
- Norwegian Centre for E-Health Research, Tromsø, Norway
| | - Stefano Peluso
- Department of Statistics and Quantitative Methods, University of Milan - Bicocca, Milan, Italy
| | - Alessio Signori
- Section of Biostatistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Antonio Di Biagio
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Anna Marchese
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Microbiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cristina Campi
- Department of Mathematics (DIMA), University of Genoa, Genoa, Italy
- Life Science Computational Laboratory (LISCOMP), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Beshah D, Desta A, Belay G, Abebe T, Gebreselasie S, Sisay Tessema T. Antimicrobial Resistance and Associated Risk Factors of Gram-Negative Bacterial Bloodstream Infections in Tikur Anbessa Specialized Hospital, Addis Ababa. Infect Drug Resist 2022; 15:5043-5059. [PMID: 36068835 PMCID: PMC9441145 DOI: 10.2147/idr.s371654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background Bloodstream infections (BSIs) are significant causes of morbidity and mortality in Ethiopia and worldwide. Alarming is the rapid global spread of antimicrobial resistance (AMR) in bacteria. Objective To determine the microbial profile, antimicrobial susceptibility pattern, and associated risk factors for bloodstream infections in Tikur Anbessa Specialized Hospital (TASH) Addis Ababa Ethiopia. Methods A cross-sectional study was conducted between September 2018 and March 2019. Blood collected twice from each septicemia suspected patient were processed following standard bacteriological procedures. AST was performed by using the disk diffusion test according to CLSI 2017 and 2018 guidelines. Data captured in Epidata were cleaned and analyzed by SPSS version 21 software. Results The prevalence of BSI was 28.06% and a higher proportion of pathogene detected were gram-negative bacteria (GNB) (54.5%) and gram-positive bacteria (GPB) (45.43%). The most abundant bacterial species were Klebsiella pneumoniae 17.6%, CoNS 15.2%, and Acinetobacter spp 11.0%. Culture positivity was associated with age below 6 years, neonates AOR p=<0.001, infants AOR p=<0.001, Pre-school P=0.002, ICU admission COR p=<0.001, length of admission >5 days COR P=0.016, temperature greater than 38°C, AOR p=0.013, instrument usage during medical care AOR, p=<0.001, chronic illness AOR p=0.027, and neonatal incubation AOR p=0.013. GNB average drug resistance rate was 57.9% of the commonly used antibiotics and the most efficient and inefficient drugs were amikacin (10.8%) and ampicillin (94.6%). The gram-negative isolates showed a 95.3% rate of multi-drug resistance; and MDR, XDR, and PDR were observed at 55.8%, 32.2%, and 7.3%, of isolates respectively. This finding shows children especially neonates were highly affected by drug resistant BSI. Conclusion Pediatric patients and ICU patients are more affected by BSI, and drug-resistant bacteria are a major problem. Therefore, appropriate intervention approaches need to be implemented.
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Affiliation(s)
- Daniel Beshah
- Microbial Cellular Molecular Biology Infection Biology Stream, College of Natural and Computational Science, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Diagnostic Laboratory, Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Correspondence: Daniel Beshah, Microbial Cellular Molecular Biology infection Biology stream, College of Natural and Computational Science, Addis Ababa University, Addis Ababa, Ethiopia, Tel +251 911151317, Email ;
| | - Adey Desta
- Microbial Cellular Molecular Biology Infection Biology Stream, College of Natural and Computational Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gurja Belay
- Microbial Cellular Molecular Biology Infection Biology Stream, College of Natural and Computational Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamrat Abebe
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Gebreselasie
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Brescini L, Mazzanti S, Morroni G, Pallotta F, Masucci A, Orsetti E, Montalti R, Barchiesi F. Candidemia in Internal Medicine: Facing the New Challenge. Mycopathologia 2022; 187:181-188. [PMID: 35298733 PMCID: PMC9124164 DOI: 10.1007/s11046-022-00624-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 03/03/2022] [Indexed: 11/18/2022]
Abstract
Candidemia is an alarming problem in critically ill patients including those admitted in Internal Medicine Wards (IMWs). Here, we analyzed all cases of candidemia in adult patients hospitalized over nine years (2010–2018) in IMWs of a 980-bedded University Hospital of Ancona, Italy. During the study period, 218/505 (43%) episodes of candidemia occurred in IMWs patients. The cumulative incidence was 2.5/1000 hospital admission and increased significantly over time (p = 0.013). Patients were predominantly male, with a median age of 68 years. Cardiovascular diseases and solid tumors were the most frequent comorbidities. Candida albicans accounted for 51% of the cases, followed by C. parapsilosis (25%), C. tropicalis (9%) and C. glabrata (7%). Thirty-day mortality was 28% and did not increased significantly over time. By multivariate logistic regression analysis, the presence of neutropenia (OR 7.247 [CI95% 1,368–38,400; p = 0.020]), pneumonia (OR 2.323 [CI95% 1,105–4,884; p = 0.026]), and being infected with C. albicans (OR 2.642 [95% CI 1,223–5,708; p = 0.013) emerged as independent predictors of mortality. The type of antifungal therapy did not influence the outcome. Overall, these data indicate that patients admitted to IMWs are increasingly at higher risk of developing candidemia. Mortality rate remains high and significantly associated with both microbiologic- and host-related factors.
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Affiliation(s)
- Lucia Brescini
- Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Ancona, Italy.,Clinica Malattie Infettive Azienda Ospedaliera Universitaria Ospedali Riuniti Umberto I°-Lancisi-Salesi, Ancona, Italy
| | - Sara Mazzanti
- Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Ancona, Italy.,Clinica Malattie Infettive Azienda Ospedaliera Universitaria Ospedali Riuniti Umberto I°-Lancisi-Salesi, Ancona, Italy
| | - Gianluca Morroni
- Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Ancona, Italy
| | - Francesco Pallotta
- Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Ancona, Italy
| | - Annamaria Masucci
- Laboratorio di Microbiologia, Azienda Ospedaliera Universitaria Ospedali Riuniti Umberto I°-Lancisi-Salesi, Ancona, Italy
| | - Elena Orsetti
- Azienda Ospedaliera Universitaria Ospedali Riuniti Umberto I°-Lancisi-Salesi, Ancona, Italy.,Malattie Infettive, Ospedale Murri, Fermo, Italy
| | - Roberto Montalti
- Unità di Chirurgia Epato-Bilio-Pancreatica, Mininvasiva e Robotica, Dipartimento di Sanità Pubblica, Università Federico II, Napoli, Italy
| | - Francesco Barchiesi
- Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Ancona, Italy. .,Malattie Infettive, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy.
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Casagrande Pierantoni D, Corte L, Casadevall A, Robert V, Cardinali G, Tascini C. How does temperature trigger biofilm adhesion and growth in Candida albicans and two non-Candida albicans Candida species? Mycoses 2021; 64:1412-1421. [PMID: 33894074 PMCID: PMC8597170 DOI: 10.1111/myc.13291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Biofilm formation on biotic and abiotic surfaces is finely regulated by genetic factors but also by oxygen concentration, pH, temperature and other environmental factors, already extensively explored for bacterial biofilms. Much less is known about fungal biofilm, that is considered a virulence factor for Candida pathogenic species among the few fungal species able to grow and survive at high temperatures such as 37°C as well as those induced by fever. The resistance to high temperatures coupled with the ability to form biofilm are threatening factors of these fungal species that could severely impact at an epidemiological level. OBJECTIVES In this framework, we decided to study the thermal tolerance of biofilms formed by three medical relevant species such as Candida albicans and two non-Candida albicans Candida species. METHODS Thirty nosocomial strains were investigated for their ability to adhere and grow in proximity and over body temperature (from 31 to 43°C), mimicking different environmental conditions or severe febrile-like reactions. RESULTS Candida sessile cells reacted to different temperatures showing a strain-specific response. It was observed that the attachment and growth respond differently to the temperature and that mechanism of adhesion has different outputs at high temperature than the growth. CONCLUSIONS This strain-dependent response is probably instrumental to guarantee the best success to cells for the infection, attachment and growth to occur. These observations reinforce the concept of temperature as a major trigger in the evolution of these species especially in this period of increasing environmental temperatures and excessive domestic heating.
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Affiliation(s)
| | - Laura Corte
- Department of Pharmaceutical SciencesUniversity of PerugiaPerugiaItaly
| | - Arturo Casadevall
- Johns Hopkins Bloomberg School of Public HealthJHSPH Molecular, Microbiology & Immunology; JHUSOM,BaltimoreMDUSA
| | - Vincent Robert
- Westerdijk Fungal Biodiversity InstituteAD UtrechtThe Netherlands
| | | | - Carlo Tascini
- University Hospital "S. Maria della Misericordia" – Clinic of Infectious DiseasesUdineItaly
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Zheng YJ, Xie T, Wu L, Liu XY, Zhu L, Chen Y, Mao EQ, Han LZ, Chen EZ, Yang ZT. Epidemiology, species distribution, and outcome of nosocomial Candida spp. bloodstream infection in Shanghai: an 11-year retrospective analysis in a tertiary care hospital. Ann Clin Microbiol Antimicrob 2021; 20:34. [PMID: 33985505 PMCID: PMC8120712 DOI: 10.1186/s12941-021-00441-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/05/2021] [Indexed: 12/30/2022] Open
Abstract
Background The incidence of Candida bloodstream infections (BSIs), has increased over time. In this study, we aimed to describe the current epidemiology of Candida BSI in a large tertiary care hospital in Shanghai and to determine the risk factors of 28-day mortality and the impact of antifungal therapy on clinical outcomes. Methods All consecutive adult inpatients with Candida BSI at Ruijin Hospital between January 1, 2008, and December 31, 2018, were enrolled. Underlying diseases, clinical severity, species distribution, antifungal therapy, and their impact on the outcomes were analyzed. Results Among the 370 inpatients with 393 consecutive episodes of Candida BSI, the incidence of nosocomial Candida BSI was 0.39 episodes/1000 hospitalized patients. Of the 393 cases, 299 (76.1%) were treated with antifungal therapy (247 and 52 were treated with early appropriate and targeted antifungal therapy, respectively). The overall 28-day mortality rate was 28.5%, which was significantly lower in those who received early appropriate (25.5%) or targeted (23.1%) antifungal therapy than in those who did not (39.4%; P = 0.012 and P = 0.046, respectively). In multivariate Cox regression analysis, age, chronic renal failure, mechanical ventilation, and severe neutropenia were found to be independent risk factors of the 28-day mortality rate. Patients who received antifungal therapy had a lower mortality risk than did those who did not. Conclusions The incidence of Candida BSI has increased steadily in the past 11 years at our tertiary care hospital in Shanghai. Antifungal therapy influenced short-term survival, but no significant difference in mortality was observed between patients who received early appropriate and targeted antifungal therapy.
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Affiliation(s)
- Yan-Jun Zheng
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Ting Xie
- Emergency Center, Suining Central Hospital, Suining, 629000, Sichuan Province, China
| | - Lin Wu
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Ying Liu
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling Zhu
- Department of Emergency, Ruijin North Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201801, China
| | - Ying Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - En-Qiang Mao
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Li-Zhong Han
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Er-Zhen Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Zhi-Tao Yang
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China. .,Pôle Sino-Français de Recherches en Science du Vivant Et Génomique, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Zarnowski R, Jaromin A, Zagórska A, Dominguez EG, Sidoryk K, Gubernator J, Andes DR. A Label-Free Cellular Proteomics Approach to Decipher the Antifungal Action of DiMIQ, a Potent Indolo[2,3- b]Quinoline Agent, against Candida albicans Biofilms. Int J Mol Sci 2020; 22:ijms22010108. [PMID: 33374351 PMCID: PMC7795236 DOI: 10.3390/ijms22010108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022] Open
Abstract
Candida albicans forms extremely drug-resistant biofilms, which present a serious threat to public health globally. Biofilm-based infections are difficult to treat due to the lack of efficient antifungal therapeutics, resulting in an urgent demand for the development of novel antibiofilm strategies. In this study, the antibiofilm activity of DiMIQ (5,11-dimethyl-5H-indolo[2,3-b]quinoline) was evaluated against C. albicans biofilms. DiMIQ is a synthetic derivative of indoquinoline alkaloid neocryptolepine isolated from a medicinal African plant, Cryptolepis sanguinolenta. Antifungal activity of DiMIQ was determined using the XTT assay, followed by cell wall and extracellular matrix profiling and cellular proteomes. Here, we demonstrated that DiMIQ inhibited C. albicans biofilm formation and altered fungal cell walls and the extracellular matrix. Cellular proteomics revealed inhibitory action against numerous translation-involved ribosomal proteins, enzymes involved in general energy producing processes and select amino acid metabolic pathways including alanine, aspartate, glutamate, valine, leucine and isoleucine. DiMIQ also stimulated pathways of cellular oxidation, metabolism of carbohydrates, amino acids (glycine, serine, threonine, arginine, phenylalanine, tyrosine, tryptophan) and nucleic acids (aminoacyl-tRNA biosynthesis, RNA transport, nucleotide metabolism). Our findings suggest that DiMIQ inhibits C. albicans biofilms by arresting translation and multidirectional pathway reshaping of cellular metabolism. Overall, this agent may provide a potent alternative to treating biofilm-associated Candida infections.
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Affiliation(s)
- Robert Zarnowski
- Department of Medicine, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, WI 53706, USA; (E.G.D.); (D.R.A.)
- Department of Medical Microbiology, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, WI 53706, USA
- Correspondence: (R.Z.); (A.J.); Tel.: +1-608-265-8578 (R.Z.); +48-71-375-6203 (A.J.)
| | - Anna Jaromin
- Department of Lipids and Liposomes, Faculty of Biotechnology, University of Wroclaw, 50-383 Wroclaw, Poland;
- Correspondence: (R.Z.); (A.J.); Tel.: +1-608-265-8578 (R.Z.); +48-71-375-6203 (A.J.)
| | - Agnieszka Zagórska
- Department of Medicinal Chemistry, Jagiellonian University Medical College, 30-688 Cracow, Poland;
| | - Eddie G. Dominguez
- Department of Medicine, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, WI 53706, USA; (E.G.D.); (D.R.A.)
- Department of Medical Microbiology, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Katarzyna Sidoryk
- Department of Pharmacy, Cosmetic Chemicals and Biotechnology, Team of Chemistry, Łukasiewicz Research Network-Industrial Chemistry Institute, 01-793 Warsaw, Poland;
| | - Jerzy Gubernator
- Department of Lipids and Liposomes, Faculty of Biotechnology, University of Wroclaw, 50-383 Wroclaw, Poland;
| | - David R. Andes
- Department of Medicine, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, WI 53706, USA; (E.G.D.); (D.R.A.)
- Department of Medical Microbiology, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, WI 53706, USA
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Zatta M, Di Bella S, Giacobbe DR, Del Puente F, Merelli M, Azzini AM, Brugnaro P, Vedovelli C, Cattelan AM, Busetti M, Gatti G, Bassetti M, Luzzati R. Clinical Features and Mortality of Nosocomial Candidemia in Very Old Patients: A Multicentre Italian Study. Gerontology 2020; 66:532-541. [PMID: 33070136 DOI: 10.1159/000510638] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/04/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Being elderly is a well-known risk factor for candidemia, but few data are available on the prognostic impact of candidemia in the very old (VO) subjects, as defined as people aged ≥75 years. OBJECTIVE The aim of this study was to assess risk factors for nosocomial candidemia in two groups of candidemia patients, consisting of VO patients (≥75 years) and adult and old (AO) patients (18-74 years). In addition, risk factors for death (30-day mortality) were analysed separately in the two groups. METHODS We included all consecutive candidemia episodes from January 2011 to December 2013 occurring in six referral hospitals in north-eastern Italy. RESULTS A total of 683 nosocomial candidemia episodes occurred. Of those, 293 (42.9%) episodes were in VO and 390 (57.1%) in AO patients. Hospitalization in medical wards, chronic renal failure, urinary catheter, and peripheral parenteral nutrition (PPN) were more common in VO than in AO patients. In the former patient group, adequate antifungal therapy (73.2%) and central venous catheter (CVC) removal (67.6%) occurred less frequently than in AO patients (82.5 and 80%, p < 0.002 and p < 0.004, respectively). Thirty-day mortality was higher in VO compared to AO patients (47.8 vs. 23.6%, p < 0.0001). In AO patients, independent risk factors for death were age (OR 1.04, 95% CI 1.00-1.09, p = 0.038), recent history of chemotherapy (OR 22.01, 95% CI 3.12-155.20, p = 0.002), and severity of sepsis (OR 40.68, 95% CI 7.42-223.10, p < 0.001); CVC removal was associated with higher probability of survival (OR 0.10, 95% CI 0.03-0.33, p < 0.001). In VO patients, independent risk factors for death were PPN (OR 3.5, 95% CI 1.17-10.47, p = 0.025) and hospitalization in medical wards (OR 2.58, 95% CI 1.02-6.53, p = 0.046), while CVC removal was associated with improved survival (OR 0.40, 95% CI 0.16-1.00, p = 0.050). CONCLUSION Thirty-day mortality was high among VO patients and was associated with inadequate management of candidemia, especially in medical wards.
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Affiliation(s)
- Marta Zatta
- Infectious Diseases Unit, University Hospital of Trieste, Trieste, Italy,
| | - Stefano Di Bella
- Infectious Diseases Unit, University Hospital of Trieste, Trieste, Italy
| | | | - Filippo Del Puente
- Clinica Malattie Infettive, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Maria Merelli
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | | | | | | | - Anna Maria Cattelan
- Infectious and Tropical Diseases Division, University Hospital, Padua, Italy
| | - Marina Busetti
- Laboratory for Microbiology, University Hospital, Trieste, Italy
| | - Giuseppe Gatti
- Division of Cardiac Surgery, University Hospital, Trieste, Italy
| | - Matteo Bassetti
- Clinica Malattie Infettive, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Roberto Luzzati
- Infectious Diseases Unit, University Hospital of Trieste, Trieste, Italy
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Zuo YH, Wang WQ, Chen QJ, Liu B, Zhang FY, Jin XY, Hang JQ, Li HY, Bao ZY, Jie ZJ, Wang GF, Gao XW, Sun H, Xu JF, Zhang J, Qu JM. Candida in Lower Respiratory Tract Increases the Frequency of Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Retrospective Case-Control Study. Front Cell Infect Microbiol 2020; 10:538005. [PMID: 33117725 PMCID: PMC7561360 DOI: 10.3389/fcimb.2020.538005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/02/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To explore impact of Candida on the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) outcome. Methods: A retrospective, multi-center, case-control study was performed. Patients hospitalized for AECOPD in 25 centers during Jan 2011-Dec 2016 were enrolled. Data were collected, including demographic information, conditions during the stable phase of COPD, clinical characteristics of AECOPD, and follow-up information within 1 year after discharge. Univariate analysis and binary logistic regression were applied, and p < 0.05 was regarded as significant. Results: Totally 1,103 patients were analyzed, with 644 lower respiratory airway (LTR) Candida positive cases and 459 Candida negative controls. Long-term prognosis was significantly different between Candida positive and negative group, including the recurrent AECOPD within 180 days (75.5 vs. 6.6%, p < 0.001) and mortality within 1 year (6.9 vs. 0.4%, p < 0.001). Univariate logistic analysis showed that LTR Candida isolation was related to higher recurrence rate of AECOPD within 180 days and mortality within 1 year. Binary logistic regression analysis demonstrated that LTR Candida isolation was independently associated with recurrence of AECOPD within 180 days. Conclusions: LTR Candida isolation was associated with worse long-term prognosis of AECOPD and independently related to higher risks of recurrent AECOPD within 180 days.
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Affiliation(s)
- Yi-hui Zuo
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei-qin Wang
- Department of Respiratory Medicine, Tongren Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Respiratory Medicine, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qi-jian Chen
- Department of Respiratory Medicine, School of Medicine, Ruijin North Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Liu
- Department of Respiratory Medicine, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Feng-ying Zhang
- Department of Respiratory Medicine, Shanghai Putuo District People's Hospital, Shanghai, China
| | - Xiao-yan Jin
- Department of Respiratory Medicine, Tongren Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing-qing Hang
- Department of Respiratory Medicine, Shanghai Putuo District People's Hospital, Shanghai, China
| | - Hua-yin Li
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhi-yao Bao
- Department of Respiratory Medicine, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi-jun Jie
- Department of Respiratory Medicine, Shanghai Fifth' Peoples Hospital, Fudan University, Shanghai, China
| | - Gui-fang Wang
- Department of Respiratory Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xi-wen Gao
- Department of Respiratory Medicine, Central Hospital of Minhang District, Shanghai, Fudan University, Shanghai, China
| | - He Sun
- Department of Respiratory Medicine, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jin-fu Xu
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Jing Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie-ming Qu
- Department of Respiratory Medicine, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
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10
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Ripoli A, Sozio E, Sbrana F, Bertolino G, Pallotto C, Cardinali G, Meini S, Pieralli F, Azzini AM, Concia E, Viaggi B, Tascini C. Personalized machine learning approach to predict candidemia in medical wards. Infection 2020; 48:749-759. [PMID: 32740866 DOI: 10.1007/s15010-020-01488-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/21/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Candidemia is a highly lethal infection; several scores have been developed to assist the diagnosis process and recently different models have been proposed. Aim of this work was to assess predictive performance of a Random Forest (RF) algorithm for early detection of candidemia in the internal medical wards (IMWs). METHODS A set of 42 potential predictors was acquired in a sample of 295 patients (male: 142, age: 72 ± 15 years; candidemia: 157/295; bacteremia: 138/295). Using tenfold cross-validation, a RF algorithm was compared with a classic stepwise multivariable logistic regression model; discriminative performance was assessed by C-statistics, sensitivity and specificity, while calibration was evaluated by Hosmer-Lemeshow test. RESULTS The best tuned RF algorithm demonstrated excellent discrimination (C-statistics = 0.874 ± 0.003, sensitivity = 84.24% ± 0.67%, specificity = 91% ± 2.63%) and calibration (Hosmer-Lemeshow statistics = 12.779 ± 1.369, p = 0.120), markedly greater than the ones guaranteed by the classic stepwise logistic regression (C-statistics = 0.829 ± 0.011, sensitivity = 80.21% ± 1.67%, specificity = 84.81% ± 2.68%; Hosmer-Lemeshow statistics = 38.182 ± 15.983, p < 0.001). In addition, RF suggests a major role of in-hospital antibiotic treatment with microbioma highly impacting antimicrobials (MHIA) that are found as a fundamental risk of candidemia, further enhanced by TPN. When in-hospital MHIA therapy is not performed, PICC is the dominant risk factor for candidemia, again enhanced by TPN. When PICC is not used and MHIA therapy is not performed, the risk of candidemia is minimum, slightly increased by in-hospital antibiotic therapy. CONCLUSION RF accurately estimates the risk of candidemia in patients admitted to IMWs. Machine learning technique might help to identify patients at high risk of candidemia, reduce the delay in empirical treatment and improve appropriateness in antifungal prescription.
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Affiliation(s)
- Andrea Ripoli
- Bioengineering Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Emanuela Sozio
- Emergency Department, North-West District, Tuscany Health Care, Spedali Riuniti Livorno, Livorno, Italy
| | - Francesco Sbrana
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Via Moruzzi,1, 56124, Pisa, Italy.
| | - Giacomo Bertolino
- Pharmaceutical Department, ASSL Cagliari, Cagliari, Italy.,Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Carlo Pallotto
- UOC Malattie Infettive, Ospedale San Donato Arezzo, Sud-Est District, Tuscany Health Care, Arezzo, Italy.,Sezione Di Malattie Infettive, Dipartimento Di Medicina, Università Di Perugia, Perugia, Italy
| | - Gianluigi Cardinali
- Department of Pharmaceutical Sciences-Microbiology, University of Perugia, Perugia, Italy.,CEMIN, Centre of Excellence On Nanostructured Innovative Materials, Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy
| | - Simone Meini
- Internal Medicine Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Filippo Pieralli
- Intermediate Care Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Anna Maria Azzini
- Dipartimento Di Diagnostica E Sanità Pubblica, Sezione Di Malattie Infettive, Università Di Verona, Verona, Italy
| | - Ercole Concia
- Dipartimento Di Diagnostica E Sanità Pubblica, Sezione Di Malattie Infettive, Università Di Verona, Verona, Italy
| | - Bruno Viaggi
- Department of Anesthesia, Neuro Intensive Care Unit, Careggi Universital Hospital, Florence, Italy
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera Dei Colli, Napoli, Italy
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11
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Bassetti M, Vena A, Meroi M, Cardozo C, Cuervo G, Giacobbe DR, Salavert M, Merino P, Gioia F, Fernández-Ruiz M, López-Cortés LE, Almirante B, Escolà-Vergé L, Montejo M, Aguilar-Guisado M, Puerta-Alcalde P, Tasias M, Ruiz-Gaitán A, González F, Puig-Asensio M, Marco F, Pemán J, Fortún J, Aguado JM, Soriano A, Carratalá J, Garcia-Vidal C, Valerio M, Sartor A, Bouza E, Muñoz P. Factors associated with the development of septic shock in patients with candidemia: a post hoc analysis from two prospective cohorts. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:117. [PMID: 32216822 PMCID: PMC7099832 DOI: 10.1186/s13054-020-2793-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/17/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Almost one third of the patients with candidemia develop septic shock. The understanding why some patients do and others do not develop septic shock is very limited. The objective of this study was to identify variables associated with septic shock development in a large population of patients with candidemia. METHODS A post hoc analysis was performed on two prospective, multicenter cohort of patients with candidemia from 12 hospitals in Spain and Italy. All episodes occurring from September 2016 to February 2018 were analyzed to assess variables associated with septic shock development defined according to The Third International Consensus Definition for Sepsis and Septic Shock (Sepsis-3). RESULTS Of 317 candidemic patients, 99 (31.2%) presented septic shock attributable to candidemia. Multivariate logistic regression analysis identifies the following factors associated with septic shock development: age > 50 years (OR 2.57, 95% CI 1.03-6.41, p = 0.04), abdominal source of the infection (OR 2.18, 95% CI 1.04-4.55, p = 0.04), and admission to a general ward at the time of candidemia onset (OR 0.21, 95% CI, 0.12-0.44, p = 0.001). Septic shock development was independently associated with a greater risk of 30-day mortality (OR 2.14, 95% CI 1.08-4.24, p = 0.02). CONCLUSIONS Age and abdominal source of the infection are the most important factors significantly associated with the development of septic shock in patients with candidemia. Our findings suggest that host factors and source of the infection may be more important for development of septic shock than intrinsic virulence factors of organisms.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Piazzale Santa Maria della Misericordia 15, 33010, Udine, Italy. .,Department of Health Sciences, University of Genoa, Genoa, Italy. .,Clinica Malattie Infettive, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.
| | - Antonio Vena
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Piazzale Santa Maria della Misericordia 15, 33010, Udine, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Marco Meroi
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Piazzale Santa Maria della Misericordia 15, 33010, Udine, Italy
| | - Celia Cardozo
- Hospital Clínic, IDIBAPS (Institut d'Investigacions biomèdiques Agust Pi i Sunyer), Universitat de Barcelona, Barcelona, Spain
| | - Guillermo Cuervo
- Hospital Universitari de Bellvitge, IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain
| | - Daniele Roberto Giacobbe
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | | | - Paloma Merino
- Hospital Universitario Clínico "San Carlos", Madrid, Spain
| | | | - Mario Fernández-Ruiz
- Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Eduardo López-Cortés
- Unidad Clínica de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena/Instituto de Biomedicina de Sevilla (IBiS)/Universidad de Sevilla/Centro Superior de Investigaciones Científicas, Seville, Spain
| | - Benito Almirante
- Hospital Universitari Vall d'Hebron, VHIR (Vall d'Hebron Institut de Recerca), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Escolà-Vergé
- Hospital Universitari Vall d'Hebron, VHIR (Vall d'Hebron Institut de Recerca), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Pedro Puerta-Alcalde
- Hospital Clínic, IDIBAPS (Institut d'Investigacions biomèdiques Agust Pi i Sunyer), Universitat de Barcelona, Barcelona, Spain
| | - Mariona Tasias
- Hospital Universitari I Politecnic "La Fe", Valencia, Spain
| | | | | | - Mireia Puig-Asensio
- Hospital Universitari Vall d'Hebron, VHIR (Vall d'Hebron Institut de Recerca), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Marco
- Hospital Clínic, IDIBAPS (Institut d'Investigacions biomèdiques Agust Pi i Sunyer), Universitat de Barcelona, Barcelona, Spain
| | - Javier Pemán
- Hospital Universitari I Politecnic "La Fe", Valencia, Spain
| | - Jesus Fortún
- Hospital Universitario "Ramón y Cajal", Madrid, Spain
| | - Jose Maria Aguado
- Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense de Madrid, Madrid, Spain
| | - Alejandro Soriano
- Hospital Clínic, IDIBAPS (Institut d'Investigacions biomèdiques Agust Pi i Sunyer), Universitat de Barcelona, Barcelona, Spain
| | - Jordi Carratalá
- Hospital Universitari de Bellvitge, IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Hospital Clínic, IDIBAPS (Institut d'Investigacions biomèdiques Agust Pi i Sunyer), Universitat de Barcelona, Barcelona, Spain
| | - Maricela Valerio
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Madrid, Spain
| | - Assunta Sartor
- Microbiology Unit, Azienda Sanitaria Universitaria Integrata Santa Maria della Misericordia, Udine, Italy
| | - Emilio Bouza
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Madrid, Spain.,Medicine Department School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Udine, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Madrid, Spain.,Medicine Department School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Udine, Spain
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12
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Siopi M, Tarpatzi A, Kalogeropoulou E, Damianidou S, Vasilakopoulou A, Vourli S, Pournaras S, Meletiadis J. Epidemiological Trends of Fungemia in Greece with a Focus on Candidemia during the Recent Financial Crisis: a 10-Year Survey in a Tertiary Care Academic Hospital and Review of Literature. Antimicrob Agents Chemother 2020; 64:e01516-19. [PMID: 31871083 PMCID: PMC7038287 DOI: 10.1128/aac.01516-19] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/15/2019] [Indexed: 01/05/2023] Open
Abstract
Updated information on the epidemiology of candidemia, particularly during severe socioeconomic events, is important for proper management of these infections. A systematic literature review on candidemia in Greece and a retrospective surveillance study were conducted in a tertiary university hospital during the years of the recent financial crisis (2009 to 2018) in order to assess changes in incidence rates, patient characteristics, species distribution, antifungal susceptibilities, and drug consumption. The average annual incidence of 429 candidemic episodes was 2.03/10,000 bed days, with 9.88 in adult intensive care units (ICUs), 1.74 in surgical wards, and 1.81 in internal medicine wards, where a significant increase was observed (1.15, 1.85, and 2.23/10,000 bed days in 2009 to 2011, 2012 to 2014, and 2015 to 2018, respectively; P = 0.004). Candida albicans was the most common species (41%), followed by Candida parapsilosis species complex [SC] (37%), Candida glabrata SC (11%), Candida tropicalis (7%), Candida krusei (1%), and other rare Candida spp. (3%). Mixed infections were found in 20/429 (4.7%) cases, while 33 (7%) cases were due to non-Candida spp. Overall, 44/311 (14%) isolates were resistant/non-wild type (WT) to the nine antifungals tested, with 23/113 (20%) C. parapsilosis SC and 2/34 (6%) C. glabrata SC isolates being resistant to fluconazole (1 panechinocandin and 2 panazole resistant). All isolates were susceptible/WT to amphotericin B and flucytosine. While the overall consumption of antifungals diminished (P = 0.02), with a mean of 17.93 defined daily doses (DDD)/100 bed days, increased micafungin use was correlated with the rise in C. parapsilosis SC (P = 0.04). A significant increase of candidemia in internal medicine wards and of C. parapsilosis SC infections was found during the years of financial crisis. Although resistance rates remain low (<14%), fluconazole-resistant C. parapsilosis SC and multidrug-resistant C. glabrata SC isolates are of major concern.
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Affiliation(s)
- Maria Siopi
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Tarpatzi
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Kalogeropoulou
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Damianidou
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Vasilakopoulou
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Vourli
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyros Pournaras
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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13
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Pinto-Magalhães S, Martins A, Lacerda S, Filipe R, Prista-Leão B, Pinheiro D, Silva-Pinto A, Santos L. Candidemia in a Portuguese tertiary care hospital: Analysis of a 2-year period. J Mycol Med 2019; 29:320-324. [PMID: 31444130 DOI: 10.1016/j.mycmed.2019.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/17/2019] [Accepted: 08/10/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Candidemia is a nosocomial infection of increasing importance, associated with high morbidity and mortality. The aim of this study is to describe the species distribution, risk factors, management and outcomes of patients with candidemia. METHODS We conducted a retrospective study at Centro Hospitalar Universitário de São João, Portugal, between January 2016 and December 2017. RESULTS A total of 117 candidemia episodes (n=114 patients) were included. Median age was 65 years, with an increased prevalence of older ages. Candida albicans (51.3%) was the most prevalent species, followed by C. glabrata (22.2%), C. parapsilosis (15.4%), C. tropicalis (4.3%) and C. lusitaniae (2.6%). Forty-two patients (35.9%) did not receive antifungal drugs after diagnosis of candidemia. Echinocandins were used as first-line drug therapy in half of the treated patients (50.7%). The median EQUAL Candida Score was 6/17 (IQR 6-9) for patients without central venous catheter (CVC) and 11/20 (IQR 6-14) for patients with CVC. The 30 days-mortality was 31,6% and was not significantly associated with the timing of antifungal therapy and the EQUAL Candida Score. CONCLUSION The distribution of Candida species has changed in recent years, with an increase in the proportion of C. albicans and C. glabrata. Rapid diagnostic tests, empiric antifungal therapy and source control are essential to improve the prognosis of patients with candidemia. More multicentric prospective studies are needed to evaluate the association of mortality with the timing of antifungal therapy or the EQUAL Candida Score.
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Affiliation(s)
- S Pinto-Magalhães
- Faculty of Medicine of the University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - A Martins
- Faculty of Medicine of the University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal; Infectious Diseases Department, Centro Hospitalar Universitário de São João, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal
| | - S Lacerda
- Faculty of Medicine of the University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal; Infectious Diseases Department, Centro Hospitalar Universitário de São João, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal
| | - R Filipe
- Faculty of Medicine of the University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal; Infectious Diseases Department, Centro Hospitalar Universitário de São João, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal
| | - B Prista-Leão
- Faculty of Medicine of the University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal; Infectious Diseases Department, Centro Hospitalar Universitário de São João, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal
| | - D Pinheiro
- Microbiology Laboratory, Clinical Pathology Department, Centro Hospitalar Universitário de São João, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal
| | - A Silva-Pinto
- Faculty of Medicine of the University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal; Infectious Diseases Department, Centro Hospitalar Universitário de São João, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal
| | - L Santos
- Faculty of Medicine of the University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal; Infectious Diseases Department, Centro Hospitalar Universitário de São João, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal
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14
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Menichetti F, Bertolino G, Sozio E, Carmignani C, Rosselli Del Turco E, Tagliaferri E, Sbrana F, Ripoli A, Barnini S, Desideri I, Dal Canto L, Tascini C. Impact of infectious diseases consultation as a part of an antifungal stewardship programme on candidemia outcome in an Italian tertiary-care, University hospital. J Chemother 2019; 30:304-309. [PMID: 30843776 DOI: 10.1080/1120009x.2018.1507086] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Candidemia is a major cause of in-hospital mortality. Antifungal stewardship programme (AFSP) providing infectious diseases consultation (IDC) might improve the outcome. We evaluate the impact on candidemia mortality of IDC as part of AFSP restricting the use of all antifungals with exception of fluconazole. We retrospectively reviewed the charts of patients with documented candidemia in our hospital during the period 2012-2014 evaluating the impact of several variables on 30-days in-hospital mortality. We reviewed data on 276 patients with documented candidemia: 200 (72%) were treated without IDC and 76 (28%) with IDC. In the group without IDC, 52 patients (26%) received no antifungal therapy. Antifungals used for treating candidemia were (no IDC/IDC): azoles (74%/42%); echinocandins (0%/46%); liposomal and lipidic complex amphotericin B (0%/12%). The 30-day in-hospital mortality was respectively (no IDC/IDC) 37% vs. 20% (p = 0.011). The multivariate analysis confirmed IDC as independent factor protecting from death (OR 0.511, 95% CI 0.251-0.994; p = 0.046), together with fungemia due to non-albicans Candida (OR 0.565, 95% CI 0.327-0.977; p = 0.042). Age >65 years was associated with a higher risk of death (OR 1.989, 95% CI 1.055-3.895; p = 0.038). The additional cost for the use of echinocandins driven by IDC in the study period was €207,000. IDC, as a part of a restrictive front-end antimicrobial stewardship programme (ASP), providing a timely right choice of antifungal therapy, increases the cost of antifungal drugs but might be a contributing protective factor from mortality due to candidemia. Efforts to increase the number of IDC in patients with candidemia seems to be warranted.
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Affiliation(s)
- Francesco Menichetti
- a Infectious Diseases Unit, Cisanello Hospital , Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | - Giacomo Bertolino
- b Pharmaceutical Department , Azienda Ospedaliera Universitaria Pisana , Santa Chiara, Pisa , Italy
| | - Emanuela Sozio
- c Emergency Medicine Unit , Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | - Claudia Carmignani
- b Pharmaceutical Department , Azienda Ospedaliera Universitaria Pisana , Santa Chiara, Pisa , Italy
| | - Elena Rosselli Del Turco
- c Emergency Medicine Unit , Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | - Enrico Tagliaferri
- a Infectious Diseases Unit, Cisanello Hospital , Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | | | - Andrea Ripoli
- d Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - Simona Barnini
- e Microbiologia Universitaria, Azienda Ospedaliero Universitaria Pisana , Pisa , Italy
| | - Ielizza Desideri
- b Pharmaceutical Department , Azienda Ospedaliera Universitaria Pisana , Santa Chiara, Pisa , Italy
| | - Luana Dal Canto
- b Pharmaceutical Department , Azienda Ospedaliera Universitaria Pisana , Santa Chiara, Pisa , Italy
| | - Carlo Tascini
- f First Division of Infectious Diseases , Cotugno Hospital, Azienda Ospedaliera dei Colli , Napoli , Italy
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15
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Falcone M, Tiseo G, Venditti M, Menichetti F. Updates in the epidemiology and management of candidemia and Clostridioides difficile coinfection. Expert Rev Anti Infect Ther 2019; 17:375-382. [PMID: 30982376 DOI: 10.1080/14787210.2019.1608183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: In recent years, more and more studies have focused on the association between candidemia and Clostridioides difficile infection (CDI), highlighting the risk of subsequent candidemia in patients with CDI. However, a more recent model focuses on the Candida-Clostridioides difficile coinfection as a clinical entity in which candidemia could occur before or after the CDI episode. Areas covered: In this review we analyzed the physiopathological mechanisms underlying the Candida-Clostridioides difficile coinfection, both in case of candidemia preceding and following the CDI. We highlighted that gut alterations occurring during a CDI play a crucial role in the risk of subsequent candidemia. Moreover, we identified areas of interest about the management of Candida-Clostridioides difficile coinfection and proposed answers to relevant clinical questions. Expert opinion: The evaluation of risk factors for candidemia in patients with CDI and the rational antibiotic use in patients with candidemia remain the most efficacious and cost-free instruments to optimally manage the Candida-Clostridioides difficile coinfection. However, further studies are required to cover some unmet needs, such as the development of rapid diagnostic methods of candidemia and the use of new available drugs with minimal effect on the microbiome biodiversity in patients with CDI at high risk of fungemia.
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Affiliation(s)
- Marco Falcone
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Giusy Tiseo
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Mario Venditti
- b Department of Public Health and Infectious Diseases , 'Sapienza' University of Rome , Rome , Italy
| | - Francesco Menichetti
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
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Predicting candidemia in the internal medicine wards: a comparison with gram-negative bacteremia-a retrospectives study. Diagn Microbiol Infect Dis 2019; 95:80-83. [PMID: 31129007 DOI: 10.1016/j.diagmicrobio.2019.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 03/30/2019] [Accepted: 04/20/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Risk factors for candidemia in the internal medicine wards (IMW) are poorly characterized. Their elucidation might assist in early diagnosis and treatment. OBJECTIVES We aimed to elucidate predictors of candidemia in the IMWs comparing them to patients with gram-negative bacteremia (GNB). METHODS A retrospective study of consecutive patients with candidemia in IMWs in Beilinson hospital (2007-2016) was performed. Patient demographics, comorbidities, and clinical characteristics were documented. The comparator group was GNB patients. RESULTS Sixty-two patients with candidemia were compared with 178 patients with GNB. Candidemic patients were younger and with less body mass index > 20 kg/m2 (73 ± 15 vs. 78 ± 10, P = 0.01; 44% vs. 60%, P = <0.0001,respectively). In multivariate model, underweight, prior cephalosporin use, and central venous catheters (CVCs) were significantly associated with candidemia [odds ratio (OR) = 0.2, 95% confidence interval (CI) 0.07-0.4; OR = 4, 95% CI 1.3-11; and OR = 4, 95% CI 1.5-12, respectively]. CONCLUSION Underweight, recent cephalosporin exposure, and CVCs were statistically significant predictors of candidemia in the IMW. Using these predictors might aid in recognizing high-risk patients for candidemia in the IMWs, leading to earlier appropriate empirical treatment.
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Trovato L, Astuto M, Castiglione G, Scalia G, Oliveri S. Diagnostic surveillance by Candida albicans germ tube antibody in intensive care unit patients. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 53:778-784. [PMID: 30902614 DOI: 10.1016/j.jmii.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/23/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The diagnosis of Invasive Candidiasis (IC) presents serious problems, mainly associated with the absence of pathognomonic symptoms of the disease and the difficulty of isolating the fungus in blood culture. Candida albicans germ tube antibody (CAGTA) provides a rapid and simple test for diagnosis of IC. The aim of this study was to evaluate the diagnostic role of the CAGTA in the monitoring of critically-ill patients at risk of developing IC. METHODS During diagnostic surveillance in the intensive care units (ICU) CAGTA was performed twice a week if predetermined risk factors were present and a positive result was considered when a serum titer ≥1/160 was detected in at least one sample. RESULTS Seventy critically ill patients were included in the study. Twenty-three patients with proven/probable IC were identified. The sensitivity, specificity, PPV, and NPV of CAGTA for the diagnosis of proven/probable IC in all 70 patients were 91.3%, 68.1%, 58.3%, and 94.1%, respectively. Statistically significant highest titers were found in patients with proven/probable IC as well as increasing titers more than 1/160. CONCLUSIONS Our results suggest that detection of CAGTA could be a useful biomarker for the diagnosis of proven and probable IC in critical patients during prolonged ICU stay. During the monitoring it is opportune to evaluate the titers kinetics since the clinical diagnosis of proven/probable IC coincided with increase titer from negative (<1/160) to more than 1/160.
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Affiliation(s)
- Laura Trovato
- Department of Biomedical and Biotechnological Sciences, University of Catania, Laboratory Analysis Unit, A.O.U. "Policlinico -Vittorio Emanuele", Catania, Italy.
| | - Marinella Astuto
- Department of Anesthesia and Intensive Care, A.O.U. "Policlinico -Vittorio Emanuele", Catania, Italy
| | - Giacomo Castiglione
- Department of Anesthesia and Intensive Care, A.O.U. "Policlinico -Vittorio Emanuele", Catania, Italy
| | - Guido Scalia
- Department of Biomedical and Biotechnological Sciences, University of Catania, Laboratory Analysis Unit, A.O.U. "Policlinico -Vittorio Emanuele", Catania, Italy
| | - Salvatore Oliveri
- Department of Biomedical and Biotechnological Sciences, University of Catania, Laboratory Analysis Unit, A.O.U. "Policlinico -Vittorio Emanuele", Catania, Italy
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18
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Performance of Candida albicans germ tube antibodies (CAGTA) and its association with (1 → 3)-β-D-glucan (BDG) for diagnosis daof invasive candidiasis (IC). Diagn Microbiol Infect Dis 2019; 93:39-43. [DOI: 10.1016/j.diagmicrobio.2018.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 01/01/2023]
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Repeated antifungal use audits are essential for selecting the targets for intervention in antifungal stewardship. Eur J Clin Microbiol Infect Dis 2018; 37:1993-2000. [PMID: 30078143 DOI: 10.1007/s10096-018-3335-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
A previous audit to assess the quality of antifungal use was performed in our hospital in 2011. After 5 years of antifungal stewardship program (AFS), we performed a follow-up audit in order to describe the long-term effect of such program. Using a predefined score, we evaluated the antifungal use in 100 consecutive adult inpatients receiving systemic antifungals. Results of the present audit were compared with those of a previous one, performed in 2011, before the implementation of our AFS. After 5 years, AFS program has induced a change in the population who received antifungal drugs in our hospital with a reduction in medical patients and a relative higher prescription among hematological ones. As for indications, empirical use decreased very significantly (from 62 to 30%, p < 0.001), while tailored treatment (from 20 to 41%, p = 0.001) and prophylaxis (from 15 to 27%, p = 0.03) increased. Compared to 2011, we also observed an improvement in the optimal choice of antifungal drug, route of administration, and microbiological adjustment. However, no significant improvement was observed regarding adequacy of length of therapy or optimal dosage or administration route. Although we observed an increase in the number of optimal DOTs used, the potential estimated savings continued to be high (~ €44,199 for every 100 patients receiving antifungals). Our study is the first to show the impact on the use of antifungal drugs exerted by a prolonged non-coercive AFS program. We also demonstrate the utility of a periodic audit of antifungal use in order to point out new goals for future interventions.
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20
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Evaluation of candidemia and antifungal consumption in a large tertiary care Italian hospital over a 12-year period. Infection 2018; 46:469-476. [PMID: 29654496 DOI: 10.1007/s15010-018-1139-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/09/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE An early adequate antifungal therapy based on the knowledge of local epidemiology can reduce the candidemia-attributable mortality and the length of hospitalization. We performed a retrospective study to analyze the epidemiology of candidemia and the antifungal consumption in our hospital. METHODS We analyzed Candida spp. isolated from the blood, and their susceptibility profile from 2005 to 2016 in Careggi University Hospital, Florence, Italy. We also performed a stratified analysis by clinical setting where Candida spp. were isolated (Medical Wards, Surgery, Intensive Care Unit-ICU). Then, we retrospectively reviewed the annual consumption of antifungal agents and calculated the defined daily dosing for 10,000 hospital days. RESULTS The rate of candidemia was higher in ICU than other settings and Candida albicans was the first cause of candidemia (61.2%). After adjustment for hospital days, the rate of C. albicans showed a statistically significant parabolic trend (p < 0.001), with a peak of incidence in 2010. After 2010, we observed a reduction of candidemia due to both C. albicans and non-albicans species. Between 2005 and 2015, we reported an increasing increased use of echinocandins. As far as resistance profile is concerned, only one Candida glabrata isolate was resistant to caspofungin (1.9%) and 30% of C. glabrata were resistant to fluconazole. CONCLUSIONS Our data describe C. albicans as the first cause of candidemia in all the studied settings and the low rate of echinocandin resistance, despite their increased use over the study period. ICU was confirmed as the setting with the highest incidence of candidemia.
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Guembe M, Pérez-Granda MJ, Capdevila JA, Barberán J, Pinilla B, Bouza E. Impact of a training program on adherence to recommendations for care of venous lines in internal medicine departments in Spain. Eur J Clin Microbiol Infect Dis 2018; 37:1163-1168. [PMID: 29569044 DOI: 10.1007/s10096-018-3236-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
Abstract
A high percentage of venous lines (VLs) are placed in non-ICU patients, particularly those treated in the internal medicine department (IMD). We assessed adherence to VL care after a training program aimed at nurses and clinicians attending patients admitted to Spanish IMDs. We performed a multicenter prospective observational point prevalence study in 14 Spanish IMDs in 2013 and 2016. We included all adult patients (> 18 years) admitted to IMDs on the study day and reviewed nursing records for patients with VL in place before and after a 1-year training program during 2015. Answers from an interview with head nurses of the IMDs regarding commonly used practices in the daily management of VLs were also compared. A total of 638 and 693 patients were seen during each period, respectively, and 530 and 598 patients had ≥ 1 VL implanted (83.1 vs. 86.3%). Catheters were considered unnecessary in 12.8 and 15.0% of cases (p = 0.28). Daily recording of the need for catheter use increased from 43.8 to 71.8% (p < 0.001). Furthermore, daily monitoring of the insertion site remained very frequent (94.4 vs. 92.2%; p = 0.16). The date of insertion was recorded in 86.3 and 85.5% of cases (p = 0.73), and no combination of closed connectors with open caps increased from 74.8 to 90.3% (p < 0.001). Overall, head nurses' knowledge improved in 4 out of 14 recommendations assessed (28.6%). A simple and easy program for training on management of VLs in Spanish IMDs was associated with improved quality of care.
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Affiliation(s)
- María Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain. .,Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain. .,Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, C/ Dr. Esquerdo, 46, 28007, Madrid, Spain.
| | - María Jesús Pérez-Granda
- Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain.,Cardiac Surgery Postoperative Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Antonio Capdevila
- Grupo de Trabajo en Enfermedades Infecciosas de la Sociedad Española de Medicina Interna (GTEI-SEMI), Madrid, Spain.,Department of Internal Medicine, Hospital de Mataró, Barcelona, Spain
| | - José Barberán
- Grupo de Trabajo en Enfermedades Infecciosas de la Sociedad Española de Medicina Interna (GTEI-SEMI), Madrid, Spain.,Department of Internal Medicine, Hospital de Montepríncipe, Madrid, Spain
| | - Blanca Pinilla
- Grupo de Trabajo en Enfermedades Infecciosas de la Sociedad Española de Medicina Interna (GTEI-SEMI), Madrid, Spain.,Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Sbrana F, Sozio E, Bassetti M, Ripoli A, Pieralli F, Azzini AM, Morettini A, Nozzoli C, Merelli M, Rizzardo S, Bertolino G, Carrara D, Scarparo C, Concia E, Menichetti F, Tascini C. Independent risk factors for mortality in critically ill patients with candidemia on Italian Internal Medicine Wards. Intern Emerg Med 2018; 13:199-204. [PMID: 29322386 DOI: 10.1007/s11739-017-1783-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/25/2017] [Indexed: 12/31/2022]
Abstract
Candida is an increasing cause of bloodstream infection and is associated with significant morbidity and mortality. The aim of our study is to analyze risk factors for short-term mortality in patients with bloodstream Candida spp. infections admitted to Internal Medicine Wards (IMWs). This was a retrospective case-control study between January 2012 and December 2014 from four University Hospitals in Italy, where patients with candidemia dying within 30 days from diagnosis were matched to control cases with candidemia who survived in the same period of time. Two-hundred and fifty cases of candidemia were registered during the 36 months of enrollment. Among these, 112 patients died (45%) within 30 days from the first blood culture's positivity for Candida spp. At multivariate analysis, septic shock [odds ratio (95% CI) = 2.919 (1.62-5.35), p < 0.001] and concomitant chronic kidney failure [odds ratio (95% CI) = 2.296 (1.07-5.12), p = 0.036] were independent predictors of mortality. Low-dose chronic steroid therapy was protective [odds ratio (95% CI) = 0.461 (0.25-0.83), p = 0.011).
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Affiliation(s)
- Francesco Sbrana
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy.
| | - Emanuela Sozio
- North-West District, Tuscany HealthCare, Spedali Riuniti Livorno, Emergency Department, Leghorn, Italy
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Andrea Ripoli
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Filippo Pieralli
- Intermediate Care Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Anna Maria Azzini
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Alessandro Morettini
- Internal Medicine Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Carlo Nozzoli
- Internal Medicine Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Maria Merelli
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Sebastiano Rizzardo
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Giacomo Bertolino
- Pharmaceutical Department, Azienda Ospedaliera Universitaria Pisana, Santa Chiara, Pisa, Italy
| | - Davide Carrara
- U.O.C. Medicina Generale, Ospedale Versilia, Azienda U.S.L. Toscana Nord Ovest, Viareggio, Italy
| | - Claudio Scarparo
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Ercole Concia
- Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Francesco Menichetti
- Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
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van Engen A, Casamayor M, Kim S, Watt M, Odeyemi I. "De-escalation" strategy using micafungin for the treatment of systemic Candida infections: budget impact in France and Germany. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 9:763-774. [PMID: 29255367 PMCID: PMC5722012 DOI: 10.2147/ceor.s141548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The incidence of azole-resistant Candida infections is increasing. Consequently, guidelines for treating systemic Candida infection (SCI) recommend a “de-escalation” strategy: initial broad-spectrum antifungal agents (e.g., echinocandins), followed by switching to fluconazole if isolates are fluconazole sensitive, rather than “escalation” with initial fluconazole treatment and then switching to echinocandins if isolates are fluconazole resistant. However, fluconazole may continue to be used as first-line treatment in view of its low acquisition costs. The aim of this study was, therefore, to evaluate the budget impact of the de-escalation strategy using micafungin compared with the escalation strategy in France and Germany. Methods A budget impact model was used to compare de-escalation to escalation strategies. As well as survival, clinical success (resolution/reduction of symptoms and radiographic abnormalities associated with fungal infection), was considered, as was mycological success (eradication of Candida from the bloodstream). Health economic outcomes included cost per health state according to clinical success and mycological success, and budget impact. A 42-day time horizon was used. Results For all patients with SCI, the budget impact of using de-escalation rather than escalation was greater, but improved rates of survival, clinical success and mycological success were apparent with de-escalation. In patients with fluconazole-resistant isolates, clinical success rates and survival were improved by ~72% with de-escalation versus escalation, producing cost savings of €6,374 and €356 per patient in France and Germany, respectively; improvements of ~72% in mycological success rates with de-escalation versus escalation did not translate into cost savings. Conclusion Modeling provides evidence that when treating SCI in individuals at risk of azole-resistant infections, de-escalation from micafungin has potential cost savings associated with improved clinical success rates.
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Zaccone V, Tosoni A, Passaro G, Vallone CV, Impagnatiello M, Li Puma DD, De Cosmo S, Landolfi R, Mirijello A. Sepsis in Internal Medicine wards: current knowledge, uncertainties and new approaches for management optimization. Ann Med 2017; 49:582-592. [PMID: 28521523 DOI: 10.1080/07853890.2017.1332776] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Sepsis represents a global health problem in terms of morbidity, mortality, social and economic costs. Although usually managed in Intensive Care Units, sepsis showed an increased prevalence among Internal Medicine wards in the last decade. This is substantially due to the ageing of population and to multi-morbidity. These characteristics represent both a risk factor for sepsis and a relative contra-indication for the admission to Intensive Care Units. Although there is a lack of literature on the management of sepsis in Internal Medicine, the outcome of these patients seems to be gradually improving. This is due to Internists' increased adherence to guidelines and "bundles". The routine use of SOFA score helps physicians in the definition of septic patients, even if the optimal score has still to come. Point-of-care ultrasonography, lactates, procalcitonin and beta-d-glucan are of help for treatment optimization. The purpose of this narrative review is to focus on the management of sepsis in Internal Medicine departments, particularly on crucial concepts regarding diagnosis, risk assessment and treatment. Key Messages Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. The prevalence of sepsis is constantly increasing, affecting more hospital patients than any other disease. At least half of patients affected by sepsis are admitted to Internal Medicine wards. Adherence to guidelines, routine use of clinical and lab scores and point-of-care ultrasonography are of help for early recognition of septic patients and treatment optimization.
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Affiliation(s)
- Vincenzo Zaccone
- a Department of Medical Sciences , Gemelli Hospital, Catholic University of Rome , Rome , Italy
| | - Alberto Tosoni
- a Department of Medical Sciences , Gemelli Hospital, Catholic University of Rome , Rome , Italy
| | - Giovanna Passaro
- a Department of Medical Sciences , Gemelli Hospital, Catholic University of Rome , Rome , Italy
| | - Carla Vincenza Vallone
- a Department of Medical Sciences , Gemelli Hospital, Catholic University of Rome , Rome , Italy
| | - Michele Impagnatiello
- a Department of Medical Sciences , Gemelli Hospital, Catholic University of Rome , Rome , Italy
| | | | - Salvatore De Cosmo
- c Department of Medical Sciences , IRCCS Casa Sollievo della Sofferenza Hospital , San Giovanni Rotondo , Italy
| | - Raffaele Landolfi
- a Department of Medical Sciences , Gemelli Hospital, Catholic University of Rome , Rome , Italy
| | - Antonio Mirijello
- a Department of Medical Sciences , Gemelli Hospital, Catholic University of Rome , Rome , Italy.,c Department of Medical Sciences , IRCCS Casa Sollievo della Sofferenza Hospital , San Giovanni Rotondo , Italy
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Vena A, Bouza E, Valerio M, Padilla B, Paño-Pardo JR, Fernández-Ruiz M, Díaz Martín A, Salavert M, Mularoni A, Puig-Asensio M, Muñoz P. Candidemia in non-ICU surgical wards: Comparison with medical wards. PLoS One 2017; 12:e0185339. [PMID: 29045423 PMCID: PMC5646772 DOI: 10.1371/journal.pone.0185339] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 09/11/2017] [Indexed: 11/23/2022] Open
Abstract
Candidemia acquired outside critical care or hematological areas has received much attention in recent years; however, data on candidemia in surgical departments are very scarce. Our objectives were to describe episodes of candidemia diagnosed in surgical wards and to compare them with episodes occurring in medical wards. We performed a post hoc analysis of a prospective, multicenter study implemented in Spain during 2010–2011 (CANDIPOP project). Of the 752 episodes of candidemia, 369 (49.1%) occurred in patients admitted to surgical wards (165, 21.9%) or medical wards (204, 27.2%). Clinical characteristics associated with surgical patients were solid tumor as underlying disease, recent surgery, indwelling CVC, and parenteral nutrition. Candidemia was more commonly related to a CVC in the surgical than in the medical wards. The CVC was removed more frequently and early management was more appropriate within 48 hours of blood sampling in the surgical patients. Overall, 30-day mortality in the surgical departments was significantly lower than in medical wards (37.7% vs. 15.8%, p<0.001). Multivariate analysis revealed admission to a surgical ward and appropriate early management of candidemia as factors independently associated with a better outcome. We found that approximately 50% of episodes of candidemia occurred in non-hematological patients outside the ICU and that clinical outcome was better in patients admitted to surgical wards than in those hospitalized in medical wards. These findings can be explained by the lower severity of underlying disease, prompt administration of antifungal therapy, and central venous catheter removal.
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Affiliation(s)
- Antonio Vena
- Clinical Microbiology and Infectious Disease Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Clinica Malattie Infettive AOU Santa Maria della Misericordia Piazzale Santa Maria della Misericordia, Udine, Italy
- * E-mail: (PM); (AV)
| | - Emilio Bouza
- Clinical Microbiology and Infectious Disease Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Maricela Valerio
- Clinical Microbiology and Infectious Disease Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Belén Padilla
- Clinical Microbiology and Infectious Disease Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Mario Fernández-Ruiz
- Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Ana Díaz Martín
- Servicio Andaluz de Salud, UGC-SCCU, Sevilla, Andalucía, Spain
| | | | - Alessandra Mularoni
- Istituto mediterraneo per i trapianti e terapie ad alta specializzazione ISMETT-UPMC, Palermo, Italy
| | | | - Patricia Muñoz
- Clinical Microbiology and Infectious Disease Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- * E-mail: (PM); (AV)
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Tascini C, Sozio E, Corte L, Sbrana F, Scarparo C, Ripoli A, Bertolino G, Merelli M, Tagliaferri E, Corcione A, Bassetti M, Cardinali G, Menichetti F. The role of biofilm forming on mortality in patients with candidemia: a study derived from real world data. Infect Dis (Lond) 2017; 50:214-219. [PMID: 28988525 DOI: 10.1080/23744235.2017.1384956] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Evaluation of the role on patient mortality exerted by biofilm forming (BF) Candida strains, by using predictive clinical data. METHODS Eighty-nine strains isolated from Candida bloodstream infection, occurring in two Italian University Hospitals, were employed in this study. A random forest (RF) model was built with a procedure of iterative selection of the risk factors potentially able to predict the probability of death. The similarity between patient conditions and Bayesian clustering was calculated in order to evaluate the role of predictors in the stratification of the death risk. RESULTS Three different groups of patients with different probability of death were obtained with a RF approach: Group 1 (mortality in 33.3% of cases), Group 2 (death in 50% of cases), and Group 3 (mortality in 76.9% of cases). The comparison between these three groups showed that BF correlated well with increased mortality in patients, admitted for medical diagnosis, with high APACHE II score and treated with azoles. Early treatment within 24 h between candidemia diagnosis and the beginning of antifungal therapy was associated with the lowest of BF rate and mortality. CONCLUSIONS BF by Candida spp. seems to be clinically associated with increased mortality especially in medical patients with higher Apache II score or treated with azoles.
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Affiliation(s)
- Carlo Tascini
- a First Division of Infectious Diseases , Cotugno Hospital, Azienda Ospedaliera dei Colli , Napoli , Italy
| | - Emanuela Sozio
- b Unit of Emergency Medicine , Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | - Laura Corte
- c Department of Pharmaceutical Sciences-Microbiology , University of Perugia , Perugia , Italy.,d CEMIN (Centre of Excellence on Nanostructured Innovative Materials), Department of Chemistry, Biology and Biotechnology , University of Perugia , Perugia , Italy
| | | | - Claudio Scarparo
- f Unit of Microbiology , Santa Maria Misericordia University Hospital , Udine , Italy
| | - Andrea Ripoli
- d CEMIN (Centre of Excellence on Nanostructured Innovative Materials), Department of Chemistry, Biology and Biotechnology , University of Perugia , Perugia , Italy
| | - Giacomo Bertolino
- g Department of Pharmaceutical Sciences-Medicine management , Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | - Maria Merelli
- h Division of Infectious Diseases , Santa Maria Misericordia University Hospital , Udine , Italy
| | - Enrico Tagliaferri
- i Infectious Diseases Clinic , Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | - Antonio Corcione
- j Department of Intensive Care , Monaldi Hospital, Azienda Ospedaliera dei Colli , Napoli , Italy
| | - Matteo Bassetti
- h Division of Infectious Diseases , Santa Maria Misericordia University Hospital , Udine , Italy
| | - Gianluigi Cardinali
- c Department of Pharmaceutical Sciences-Microbiology , University of Perugia , Perugia , Italy.,d CEMIN (Centre of Excellence on Nanostructured Innovative Materials), Department of Chemistry, Biology and Biotechnology , University of Perugia , Perugia , Italy
| | - Francesco Menichetti
- i Infectious Diseases Clinic , Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
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Pyrpasopoulou A, Iosifidis E, Roilides E. Current and potential treatment options for invasiveCandidainfections. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1379392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A. Pyrpasopoulou
- Infectious Diseases Unit, 3rd Department of Paediatrics, Aristotle University School of Health Sciences, Thessaloniki, Greece
- 2nd Department of Propedeutic Internal Medicine, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - E. Iosifidis
- Infectious Diseases Unit, 3rd Department of Paediatrics, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - E. Roilides
- Infectious Diseases Unit, 3rd Department of Paediatrics, Aristotle University School of Health Sciences, Thessaloniki, Greece
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Pharkjaksu S, Chongtrakool P, Suwannakarn K, Ngamskulrungroj P. Species distribution, virulence factors, and antifungal susceptibility among Candida parapsilosis complex isolates from clinical specimens at Siriraj Hospital, Thailand, from 2011 to 2015. Med Mycol 2017; 56:426-433. [DOI: 10.1093/mmy/myx058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 07/14/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
- Sujiraphong Pharkjaksu
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand 10700
| | - Piriyaporn Chongtrakool
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand 10700
| | - Kamol Suwannakarn
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand 10700
| | - Popchai Ngamskulrungroj
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand 10700
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Posch W, Heimdörfer D, Wilflingseder D, Lass-Flörl C. Invasive candidiasis: future directions in non-culture based diagnosis. Expert Rev Anti Infect Ther 2017; 15:829-838. [PMID: 28829207 DOI: 10.1080/14787210.2017.1370373] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Delayed initial antifungal therapy is associated with high mortality rates caused by invasive candida infections, since accurate detection of the opportunistic pathogenic yeast and its identification display a diagnostic challenge. diagnosis of candida infections relies on time-consuming methods such as blood cultures, serologic and histopathologic examination. to allow for fast detection and characterization of invasive candidiasis, there is a need to improve diagnostic tools. trends in diagnostics switch to non-culture-based methods, which allow specified diagnosis within significantly shorter periods of time in order to provide early and appropriate antifungal treatment. Areas covered: within this review comprise novel pathogen- and host-related testing methods, e.g. multiplex-PCR analyses, T2 magnetic resonance, fungus-specific DNA microarrays, microRNA characterization or analyses of IL-17 as biomarker for early detection of invasive candidiasis. Expert commentary: Early recognition and diagnosis of fungal infections is a key issue for improved patient management. As shown in this review, a broad range of novel molecular based tests for the detection and identification of Candida species is available. However, several assays are in-house assays and lack standardization, clinical validation as well as data on sensitivity and specificity. This underscores the need for the development of faster and more accurate diagnostic tests.
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Affiliation(s)
- Wilfried Posch
- a Division of Hygiene and Medical Microbiology , Medical University of Innsbruck , Innsbruck , Austria
| | - David Heimdörfer
- a Division of Hygiene and Medical Microbiology , Medical University of Innsbruck , Innsbruck , Austria
| | - Doris Wilflingseder
- a Division of Hygiene and Medical Microbiology , Medical University of Innsbruck , Innsbruck , Austria
| | - Cornelia Lass-Flörl
- a Division of Hygiene and Medical Microbiology , Medical University of Innsbruck , Innsbruck , Austria
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30
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Ramos-Martínez A, Vicente-López N, Sánchez-Romero I, Padilla B, Merino-Amador P, Garnacho-Montero J, Ruiz-Camps I, Montejo M, Salavert M, Mensa J, Cuenca-Estrella M. Epidemiology and prognosis of candidaemia in elderly patients. Mycoses 2017; 60:808-817. [PMID: 28836309 DOI: 10.1111/myc.12677] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 07/16/2017] [Accepted: 07/29/2017] [Indexed: 01/29/2023]
Abstract
The aim of the study was to analyse the epidemiology and prognosis of candidaemia in elderly patients. We performed a comparison of clinical presentation of candidaemia according to age and a study of hazard factors within a prospective programme performed in 29 hospitals. One hundred and seventy-six episodes occurred in elderly patients (>75 years), 227 episodes in middle-aged patients (61-75 years) and 232 episodes in younger patients (16-60 years). Central venous catheter, parenteral nutrition, neutropenia, immunosuppressive therapy and candidaemia caused by Candida parapsilosis were less frequent in elderly patients. These patients received inadequate antifungal therapy (57.3%) more frequently than middle-aged and younger patients (40.5% P < .001). Mortality during the first week (20%) and 30 days (42%) was higher in elderly patients. The variables independently associated with mortality in elderly patients during the first 7 days were acute renal failure (OR: 2.64), Pitt score (OR: 1.57) and appropriate antifungal therapy (OR: 0.132). Primary candidaemia (OR: 2.93), acute renal failure (OR: 3.68), Pitt score (OR: 1.38), appropriate antifungal therapy (OR: 0.3) and early removal of the central catheter (OR: 0.47) were independently associated with 30-day mortality.In conclussion, inadequate antifungal treatment is frequently prescribed to elderly patients with candidaemia and is related with early and late mortality.
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Affiliation(s)
- Antonio Ramos-Martínez
- Infectious Diseases Unit (MI), Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Madrid, Spain
| | - Natalia Vicente-López
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Isabel Sánchez-Romero
- Microbiology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Belén Padilla
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Isabel Ruiz-Camps
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Miguel Montejo
- Infectious Diseases Department, Hospital de Cruces, BIlbao, Spain
| | - Miguel Salavert
- Infectious Diseases Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José Mensa
- Infectious Diseases Department, Hospital Clínic, Barcelona, Spain
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Okinaka K. Candidemia in Cancer Patients: Focus Mainly on Hematological Malignancyand Hematopoietic Stem Cell Transplantation. Med Mycol J 2017; 57:J117-23. [PMID: 27581780 DOI: 10.3314/mmj.16.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although many new antifungals have become commercially available since 2000, candidemia remains an important public health issue because of its poor prognosis. Some studies have suggested that early antifungal therapy is associated with decreased mortality; however, it is difficult to promptly diagnose candidemia because of the poor sensitivity of blood cultures. Thus, prophylaxis against Candida infection is recommended in patient groups in whom the risk of infection is high, such as allogeneic hematopoietic stem cell transplant recipients or those undergoing intensive remission-induction chemotherapy for acute leukemia. Non-Candida albicans candidemia is dominant among hematology patients, and the use of an echinocandin is recommended as the initial therapy. However, echinocandin-resistant Candida have been reported with increasing frequency, mainly in Candida glabrata. Several studies have reported that echinocandin resistance is associated with prior exposure to an echinocandin. Therefore, susceptibility testing is vital in treating severe or refractory candidemia, and the introduction of an antifungal stewardship program is recommended.
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Affiliation(s)
- Keiji Okinaka
- Division of General Internal Medicine, National Cancer Center Hospital East / Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital
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32
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Falcone M, Tiseo G, Tascini C, Russo A, Sozio E, Raponi G, Rosin C, Pignatelli P, Carfagna P, Farcomeni A, Luzzati R, Violi F, Menichetti F, Venditti M. Assessment of risk factors for candidemia in non-neutropenic patients hospitalized in Internal Medicine wards: A multicenter study. Eur J Intern Med 2017; 41:33-38. [PMID: 28314653 DOI: 10.1016/j.ejim.2017.03.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/08/2017] [Accepted: 03/04/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND An increasing prevalence of candidemia has been reported in Internal Medicine wards (IMWs). The aim of our study was to identify risk factors for candidemia among non-neutropenic patients hospitalized in IMWs. METHODS A multicenter case-control study was performed in three hospitals in Italy. Patients developing candidemia (cases) were compared to patients without candidemia (controls) matched by age, time of admission and duration of hospitalization. A logistic regression analysis identified risk factors for candidemia, and a new risk score was developed. Validation was performed on an external cohort of patients. RESULTS Overall, 951 patients (317 cases of candidemia and 634 controls) were included in the derivation cohort, while 270 patients (90 patients with candidemia and 180 controls) constituted the validation cohort. Severe sepsis or septic shock, recent Clostridium difficile infection, diabetes mellitus, total parenteral nutrition, chronic obstructive pulmonary disease, concomitant intravenous glycopeptide therapy, presence of peripherally inserted central catheter, previous antibiotic therapy and immunosuppressive therapy were factors independently associated with candidemia. The new risk score showed good area under the curve (AUC) values in both derivation (AUC 0.973 95% CI 0.809-0.997, p<0.001) and validation cohort (0.867 95% CI 0.710-0.931, p<0.001). A threshold of 3 leads to a sensitivity of 87% and a specificity of 83%. CONCLUSION Non-neutropenic patients admitted in IMWs have peculiar risk factors for candidemia. A new risk score with a good performance could facilitate the identification of candidates to early antifungal therapy.
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Affiliation(s)
- M Falcone
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy.
| | - G Tiseo
- Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Italy
| | - C Tascini
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - A Russo
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy
| | - E Sozio
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - G Raponi
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy
| | - C Rosin
- University Hospital of Trieste, Trieste, Italy
| | - P Pignatelli
- Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Italy
| | - P Carfagna
- San Giovanni Addolorata Hospital, Rome, Italy
| | - A Farcomeni
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy
| | - R Luzzati
- University Hospital of Trieste, Trieste, Italy
| | - F Violi
- Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Italy
| | - F Menichetti
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - M Venditti
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy
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Candidemia in Patients with Body Temperature Below 37°C and Admitted to Internal Medicine Wards: Assessment of Risk Factors. Am J Med 2016; 129:1330.e1-1330.e6. [PMID: 27452680 DOI: 10.1016/j.amjmed.2016.06.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/12/2016] [Accepted: 06/17/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND An increasing number of candidemia episodes has been reported in patients cared for in internal medicine wards. These usually older and frail patients may not be suspected as having candidemia because they lack fever at the onset of the episode. To identify the risk factors associated with the lack of fever at the onset of candidemia (ie, the collection of the first positive blood culture for Candida spp.) in patients cared for in internal medicine wards, we compared 2 group of patients with or without fever. METHODS We retrospectively review data charts from 3 tertiary care, university hospitals in Italy, comparing patients with or without fever at onset of candidemia. Consecutive candidemic episodes in afebrile patients and matched febrile controls were identified during the 3-year study period. Patient baseline characteristics and several infection-related variables were examined. Random forest analysis was used, given the number of predictors to be considered and the potential complexity of their relations with the onset of fever. RESULTS We identified 147 candidemic episodes without fever at onset and 147 febrile candidemia episodes. Factors associated with the lack of fever at onset of candidemia were diabetes, Clostridium difficile infection, and a shorter delta time from internal medicine wards admission to the onset of candidemia. The only variable associated with fever was the use of intravascular devices. Quite unexpectedly, antifungal therapy was administered more frequently to patients without fever, and no differences on 30-day mortality rate were documented in the 2 study groups. CONCLUSIONS Clinicians should be aware that an increasing number of patients with invasive candidiasis cared for in internal medicine wards may lack fever at onset, especially those with diabetes and C. difficile infection. Candidemia should be suspected in patients with afebrile systemic inflammatory response syndrome or in worsening clinical condition: blood cultures should be taken, and a timely and appropriate antifungal therapy should be considered.
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Tedeschi S, Tumietto F, Giannella M, Bartoletti M, Cristini F, Cioni G, Ambretti S, Carretto E, Sambri V, Sarti M, Viale P. Epidemiology and outcome of candidemia in internal medicine wards: A regional study in Italy. Eur J Intern Med 2016; 34:39-44. [PMID: 27553696 DOI: 10.1016/j.ejim.2016.08.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/13/2016] [Accepted: 08/10/2016] [Indexed: 10/21/2022]
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 <24h, 24-72h, and >72h 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 72h 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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Affiliation(s)
- Sara Tedeschi
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Fabio Tumietto
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Maddalena Giannella
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Michele Bartoletti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Cristini
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giorgio Cioni
- Internal Medicine Unit, Hospital of Pavullo nel Frignano, Modena, Italy
| | - Simone Ambretti
- Clinical Microbiology Unit, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Edoardo Carretto
- Microbiology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Vittorio Sambri
- Microbiology Unit, Hub Laboratory AUSL della Romagna, Pievesestina, Forlì-Cesena, Italy
| | - Mario Sarti
- Clinical Microbiology Unit, S. Agostino-Estense Hospital, Baggiovara, Modena, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Scudeller L, Bassetti M, Concia E, Corrao S, Cristini F, De Rosa FG, Del Bono V, Durante-Mangoni E, Falcone M, Menichetti F, Tascini C, Tumbarello M, Venditti M, Viale P, Viscoli C, Mazzone A. MEDical wards Invasive Candidiasis ALgorithms (MEDICAL):Consensus proposal for management. Eur J Intern Med 2016; 34:45-53. [PMID: 27495949 DOI: 10.1016/j.ejim.2016.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/06/2016] [Accepted: 07/08/2016] [Indexed: 01/27/2023]
Abstract
INTRODUCTION A majority of invasive Candida infections occur in medical wards; however, evidence for management in this setting is scarce and based primarily on the intensive care or surgical setting. On behalf of the Italian Society for Anti-Infective Therapy (SITA) and the Italian Federation of Associations of Hospital Doctors on Internal Medicine (FADOI), the MEDICAL group produced practical management algorithms for patients in internal medicine wards. METHODS The MEDICAL group panel, composed of 30 members from internal medicine, infectious disease, clinical pharmacology, clinical microbiology and clinical epidemiology, provided expert opinion through the RAND/UCLA method. RESULTS Seven clinical scenarios were constructed based on clinical severity and probability of invasive candidiasis. For each scenario, the appropriateness of 63 different diagnostic, imaging, management, or therapeutic procedures was determined in two Delphi rounds. The necessity for performing each appropriate procedure, was then determined in a third Delphi round. Results were summarized in algorithms. DISCUSSION The proposed algorithms provide internal medicine physicians and managers with an easy to interpret tool that is exhaustive, clear and suitable for adaption to individual local settings. Attention was paid to individual patient management and resource allocation.
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Affiliation(s)
- Luigia Scudeller
- Clinical Epidemiology Unit, Scientific Direction, IRCCS, Policlinico San Matteo Foundation, Pavia, Italy.
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Ercole Concia
- Section of Infectious Diseases, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Policlinico G B Rossi, Verona, Italy
| | - Salvatore Corrao
- Department of Internal Medicine, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Palermo, Di.Bi.M.I.S., University of Palermo, Italy
| | - Francesco Cristini
- Infectious Diseases Unit, Teaching Hospital Policlinico S. Orsola-Malpighi Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Valerio Del Bono
- Clinic of Infectious Diseases, IRCCS San Martino-IST, University of Genova, Genova, Italy
| | - Emanuele Durante-Mangoni
- Internal Medicine Section, Department of Cardiothoracic Sciences, and Division of Infectious and Transplant Medicine, Second University of Naples at Monaldi Hospital, Napoli, Italy
| | - Marco Falcone
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | | | - Carlo Tascini
- Infectious Disease Department, Cisanello Hospital, Pisa, Italy
| | - Mario Tumbarello
- Infectious Diseases Institute, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Teaching Hospital Policlinico S. Orsola-Malpighi Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Claudio Viscoli
- Clinic of Infectious Diseases, IRCCS San Martino-IST, University of Genova, Genova, Italy
| | - Antonino Mazzone
- Internal Medicine Department, Hospital of Legnano, Legnano, Italy
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Antinori S, Milazzo L, Sollima S, Galli M, Corbellino M. Candidemia and invasive candidiasis in adults: A narrative review. Eur J Intern Med 2016; 34:21-28. [PMID: 27394927 DOI: 10.1016/j.ejim.2016.06.029] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 06/12/2016] [Accepted: 06/22/2016] [Indexed: 12/29/2022]
Abstract
Candidemia and invasive candidiasis are major causes of morbidity and mortality, and their incidence is increasing because of the growing complexity of patients. Five species of Candida (Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis and Candida krusei) account for more than 90% of all diagnosed cases, but their relative frequency varies depending on the population involved, geographical region, previous anti-fungal exposure, and patient age. The best evidence regarding the anti-fungal treatment for invasive candidiasis comes from randomized controlled trials in which more than 85% of the recruited patients had candidemia. In the case of less frequent forms of invasive candidiasis, the recommendations are based on retrospective studies, meta-analyses (when available) and experts' opinions. A pre-emptive approach based on biomarkers and clinical rules is recommended because of the high rate of infection-related mortality among critically ill patients.
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Affiliation(s)
- Spinello Antinori
- Department of Clinical and Biomedical Sciences "Luigi Sacco", University of Milano, Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy.
| | - Laura Milazzo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Salvatore Sollima
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Massimo Galli
- Department of Clinical and Biomedical Sciences "Luigi Sacco", University of Milano, Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
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Epidemiology, microbiology, clinical characteristics, and outcomes of candidemia in internal medicine wards-a retrospective study. Int J Infect Dis 2016; 52:49-54. [PMID: 27663909 DOI: 10.1016/j.ijid.2016.09.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The clinical characteristics of internal medicine ward (IMW) patients with candidemia are unclear. The aim of this study was to define the clinical characteristics of candidemic IMW patients and to study the incidence, species distribution, and outcomes of these patients compared to surgical and intensive care unit (ICU) candidemic patients. METHODS A retrospective cohort of candidemic patients in IMWs, general surgery wards, and an ICU at Beilinson Hospital during the period 2007-2014 was analyzed. RESULTS A total of 118 patients with candidemia were identified in six IMWs, two general surgery wards, and one ICU in the hospital. Candida albicans was the leading causative agent (41.1%). Higher proportions of Candida parapsilosis and Candida tropicalis isolates were observed in the IMW patients. IMW patients were significantly older, with poorer functional capacity, and had more frequently been exposed to antibiotic therapy within 90 days, in particular β-lactam-β-lactamase inhibitor combinations and cephalosporins. At onset of candidemia, a significantly lower number of IMW patients were mechanically ventilated (p<0.01); these patients did not have central line catheters comparable to ICU and surgical patients (p<0.001). They were less likely to receive adequate antifungal therapy within 48h, and this was the only significant predictor of survival in these patients (p=0.028): hazard ratio 3.7 (95% confidence interval 1.14-12.5) for therapy delayed to >48h. CONCLUSIONS IMW candidemic patients account for a substantial proportion of candidemia cases and have unique characteristics and high mortality rates.
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Tascini C, Sozio E, Salini N, Sbrana F, Ripoli A, Viaggi B, Malacarne P. Risk factors for candidaemia in critically ill patients in intensive care units as compared to internal medicine wards. Infect Dis (Lond) 2016; 49:153-154. [PMID: 27550576 DOI: 10.1080/23744235.2016.1218046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Carlo Tascini
- a Infectious Diseases Clinic , Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | - Emanuela Sozio
- b Emergency Medicine Unit , Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | - Nicola Salini
- c U.O. Anestesia e Rianimazione VI° - Pronto Soccorso, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
| | | | - Andrea Ripoli
- d Fondazione Toscana "Gabriele Monasterio" , Pisa , Italy
| | - Bruno Viaggi
- e SOD Neuroanestesia e Rianimazione CTO , Azienda Ospedaliero-Universitaria Careggi , Firenze , Italy
| | - Paolo Malacarne
- c U.O. Anestesia e Rianimazione VI° - Pronto Soccorso, Azienda Ospedaliera Universitaria Pisana , Pisa , Italy
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Barchiesi F, Orsetti E, Osimani P, Catassi C, Santelli F, Manso E. Factors related to outcome of bloodstream infections due to Candida parapsilosis complex. BMC Infect Dis 2016; 16:387. [PMID: 27507170 PMCID: PMC4977692 DOI: 10.1186/s12879-016-1704-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 07/11/2016] [Indexed: 11/25/2022] Open
Abstract
Background Although Candida albicans is the most common cause of fungal blood stream infections (BSIs), infections due to Candida species other than C. albicans are rising. Candida parapsilosis complex has emerged as an important fungal pathogen and became one of the main causes of fungemia in specific geographical areas. We analyzed the factors related to outcome of candidemia due to C. parapsilosis in a single tertiary referral hospital over a five-year period. Methods A retrospective observational study of all cases of candidemia was carried out at a 980-bedded University Hospital in Italy. Data regarding demographic characteristics and clinical risk factors were collected from the patient’s medical records. Antifungal susceptibility testing was performed and MIC results were interpreted according to CLSI species-specific clinical breakpoints. Results Of 270 patients diagnosed with Candida BSIs during the study period, 63 (23 %) were infected with isolates of C. parapsilosis complex which represented the second most frequently isolated yeast after C. albicans. The overall incidence rate was 0.4 episodes/1000 hospital admissions. All the strains were in vitro susceptible to all antifungal agents. The overall crude mortality at 30 days was 27 % (17/63), which was significantly lower than that reported for C. albicans BSIs (42 % [61/146], p = 0.042). Being hospitalized in ICU resulted independently associated with a significant higher risk of mortality (HR 4.625 [CI95% 1.015–21.080], p = 0.048). Conversely, early CVC removal was confirmed to be significantly associated with a lower risk of mortality (HR 0.299 [CI95% 0.102–0.874], p = 0.027). Finally, the type of primary antifungal therapy did not influence the outcome of infection. Conclusions Candidemia due to C. parapsilosis complex, the second most commonly causative agent of yeast BSIs in our center, is characterized by a non-negligible mortality at 30 days. An early CVC removal is associated with a significant reduced mortality.
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Affiliation(s)
- Francesco Barchiesi
- Clinica Malattie Infettive; Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°- G.M. Lancisi - G. Salesi, Ancona, Italy.
| | - Elena Orsetti
- Clinica Malattie Infettive; Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°- G.M. Lancisi - G. Salesi, Ancona, Italy
| | - Patrizia Osimani
- Pediatria, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°- G.M. Lancisi - G. Salesi, Ancona, Italy
| | - Carlo Catassi
- Clinica Pediatrica; Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°- G.M. Lancisi - G. Salesi, Ancona, Italy
| | - Fabio Santelli
- Anestesia e Rianimazione Pediatrica, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°- G.M. Lancisi - G. Salesi, Ancona, Italy
| | - Esther Manso
- Laboratorio di Microbiologia, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°- G.M. Lancisi - G. Salesi, Ancona, Italy
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Luzzati R, Merelli M, Ansaldi F, Rosin C, Azzini A, Cavinato S, Brugnaro P, Vedovelli C, Cattelan A, Marina B, Gatti G, Concia E, Bassetti M. Nosocomial candidemia in patients admitted to medicine wards compared to other wards: a multicentre study. Infection 2016; 44:747-755. [PMID: 27401690 DOI: 10.1007/s15010-016-0924-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/29/2016] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Roberto Luzzati
- Infectious Disease Unit, University Hospital of Trieste, Piazzale dell' Ospitale 2, 34125, Trieste, Italy.
| | - Maria Merelli
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, 33010, Udine, Italy
| | - Filippo Ansaldi
- Department of Health Sciences, IRCCS San Martino IST, Largo R. Benzi 10, 16132, Genoa, Italy
| | - Chiara Rosin
- Infectious Disease Unit, University Hospital of Trieste, Piazzale dell' Ospitale 2, 34125, Trieste, Italy
| | - Annamaria Azzini
- Infectious Diseases Division, University Hospital, Piazzale L. Scuro 10, 37134, Verona, Italy
| | - Silvia Cavinato
- Infectious and Tropical Diseases Division, University Hospital, Via N. Giustiniani 2, 35128, Padua, Italy
| | - Pierluigi Brugnaro
- Infectious Diseases Division, Hospital of Venice, Castello 6777, 30122, Venice, Italy
| | - Claudio Vedovelli
- Infectious Diseases Division, Hospital of Bolzano, Via L. Bohler 5, 39100, Bolzano, Italy
| | - Annamaria Cattelan
- Infectious and Tropical Diseases Division, University Hospital, Via N. Giustiniani 2, 35128, Padua, Italy
| | - Busetti Marina
- Laboratory for Microbiology, University Hospital, Strada di Fiume 447, 34149, Trieste, Italy
| | - Giuseppe Gatti
- Division of Cardiac Surgery, University Hospital, Via P. Valdoni 7, 34148, Trieste, Italy
| | - Ercole Concia
- Infectious Diseases Division, University Hospital, Piazzale L. Scuro 10, 37134, Verona, Italy
| | - Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, 33010, Udine, Italy
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Exploring ecological modelling to investigate factors governing the colonization success in nosocomial environment of Candida albicans and other pathogenic yeasts. Sci Rep 2016; 6:26860. [PMID: 27246511 PMCID: PMC4887984 DOI: 10.1038/srep26860] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/04/2016] [Indexed: 01/23/2023] Open
Abstract
Two hundred seventy seven strains from eleven opportunistic species of the genus Candida, isolated from two Italian hospitals, were identified and analyzed for their ability to form biofilm in laboratory conditions. The majority of Candida albicans strains formed biofilm while among the NCAC species there were different level of biofilm forming ability, in accordance with the current literature. The relation between the variables considered, i.e. the departments and the hospitals or the species and their ability to form biofilm, was tested with the assessment of the probability associated to each combination. Species and biofilm forming ability appeared to be distributed almost randomly, although some combinations suggest a potential preference of some species or of biofilm forming strains for specific wards. On the contrary, the relation between biofilm formation and species isolation frequency was highly significant (R2 around 0.98). Interestingly, the regression analyses carried out on the data of the two hospitals separately were rather different and the analysis on the data merged together gave a much lower correlation. These findings suggest that, harsh environments shape the composition of microbial species significantly and that each environment should be considered per se to avoid less significant statistical treatments.
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Muñoz P, Valerio M, Vena A, Bouza E. Antifungal stewardship in daily practice and health economic implications. Mycoses 2016; 58 Suppl 2:14-25. [PMID: 26033252 DOI: 10.1111/myc.12329] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 11/26/2022]
Abstract
During recent years, inappropriate antifungal use has contributed to the global increase in antifungal resistance and has played a role in the shift in the aetiology of invasive fungal infections. Moreover, overuse of antifungals may also lead to higher toxicity associated with unnecessary medication exposure and to increased healthcare costs. Antifungal stewardship (AFS) programmes consist of multidisciplinary interventions, led by specialists in infectious disease, microbiology and pharmacy that cooperate and communicate with the major prescribing departments in order to optimise antifungal therapies evaluating the indication, dose, streamlining and duration. Herein, we review the available evidence for the use of AFS and their impact on health economics. We also describe our AFS program, the successive steps we followed and the main difficulties we found.
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Affiliation(s)
- Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Department of Medicine, Complutense University of Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - Maricela Valerio
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - Antonio Vena
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Department of Medicine, Complutense University of Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - Emilio Bouza
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Department of Medicine, Complutense University of Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
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Affiliation(s)
- Claudio Viscoli
- a Division of Infectious Diseases, University of Genova (DISSAL), IRCCS San Martino-IST , Genoa , Italy
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44
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Abstract
Bloodstream infections (BSI) carry a heavy burden of morbidity and mortality in modern internal medicine wards (IMW). These wards are often filled with elderly subjects with several risk factors for BSI, such as multiple comorbidities, polypharmacy, immunosuppression, and indwelling devices. Diagnosing BSI in such a setting might require a high degree of suspicion, since the clinical presentation could be affected by underlying conditions and concomitant medications, which might delay the administration of an appropriate antimicrobial therapy, an event strongly and unfavorably influencing survival. Furthermore, selecting the appropriate antimicrobial therapy to treat these patients is becoming an increasingly complex task in which all possible benefits and costs should be carefully analyzed from patient and public health perspectives. Only a specialized, continuous, and interdisciplinary approach could really improve the management of IMW patients in an era of increasing antimicrobial resistance and complexity of care.
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Affiliation(s)
- Valerio Del Bono
- a Clinica Malattie Infettive, IRCCS AOU San Martino-IST, Università di Genova , Genova , Italy
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Pini P, Bettua C, Orsi CF, Venturelli C, Forghieri F, Bigliardi S, Faglioni L, Luppi F, Serio L, Codeluppi M, Luppi M, Mussini C, Girardis M, Blasi E. Evaluation of serum (1 → 3)-β-D-glucan clinical performance: kinetic assessment, comparison with galactomannan and evaluation of confounding factors. Infection 2015; 44:223-33. [PMID: 26475482 DOI: 10.1007/s15010-015-0849-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 09/28/2015] [Indexed: 12/29/2022]
Abstract
PURPOSE We investigated the clinical performance of (1 → 3)-β-D-glucan (BG), as an early marker of invasive fungal infections (IFI), in different clinical settings. METHODS BG serum levels were assessed by Fungitell (Associates of Cape Cod, Inc), in parallel with galactomannan (GM) when requested by clinicians. By a prospective monocentric study, 270 episodes at risk or with suspect of IFI were enrolled, namely 58 proven-probable invasive aspergillosis (IA), 27 proven invasive candidiasis (IC), 11 possible IC, 16 P.jirovecii pneumonia (PJP), 4 episodes of other IFI and 154 non-IFI controls. RESULTS We found that (a) the BG overall sensitivity, specificity, positive predictive value and negative predictive value (NPV) were 87.9, 80.5, 76.7 and 89.9 %, respectively; (b) the highest sensitivity was found in the IC groups, followed by PJP, IA and other IFI groups; (c) an association was observed between BG kinetics and patients outcome; (d) in the IA episodes, the combination of BG or GM vs GM alone increased sensitivity from 60.0 to 83.3 % in the haematological patients; (e) false-positive BG results were related to Gram-negative infections or infusion of polyclonal IgM-enriched immunoglobulins, where high levels of BG were indeed detected. CONCLUSION Besides strengthening its overall good clinical performance, we provide evidence that serum BG correlates with clinical outcome and that, once used in combination with GM, BG allows to enhance IFI diagnosis rate. The high sensitivity and NPV, observed in the Intensive Care Unit setting, open to BG validation as a marker for assessment of antifungal treatment.
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Affiliation(s)
- P Pini
- Dipartimento Interaziendale Integrato di Medicina di Laboratorio e Anatomia Patologica, Struttura Complessa di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - C Bettua
- Dipartimento Interaziendale Integrato di Medicina di Laboratorio e Anatomia Patologica, Struttura Complessa di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - C F Orsi
- Dipartimento di Medicina Diagnostica, Clinica e di Sanità Pubblica, Istituti Biologici, Università di Modena e Reggio Emilia, Via Campi 287, 41125, Modena, Italy
- Dipartimento di Scienze della Salute, Università di Milano, Polo Universitario San Paolo, Milan, Italy
| | - C Venturelli
- Dipartimento Interaziendale Integrato di Medicina di Laboratorio e Anatomia Patologica, Struttura Complessa di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - F Forghieri
- Dipartimento Attività Integrata di Oncologia, Ematologia e Patologie dell'Apparato Respiratorio, Ematologia, Azienda Ospedaliero-Universitaria Policlinico, Università di Modena e Reggio Emilia, Modena, Italy
| | - S Bigliardi
- Dipartimento Attività Integrata di Oncologia, Ematologia e Patologie dell'Apparato Respiratorio, Ematologia, Azienda Ospedaliero-Universitaria Policlinico, Università di Modena e Reggio Emilia, Modena, Italy
| | - L Faglioni
- Dipartimento Attività Integrata di Oncologia, Ematologia e Patologie dell'Apparato Respiratorio, Ematologia, Azienda Ospedaliero-Universitaria Policlinico, Università di Modena e Reggio Emilia, Modena, Italy
| | - F Luppi
- Dipartimento Attività Integrata di Oncologia, Ematologia e Patologie dell'Apparato Respiratorio, Malattie dell'Apparato Respiratorio, Università di Modena e Reggio Emilia, Modena, Italy
| | - L Serio
- Divisione di Anestesiologia e Terapia Intensiva, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - M Codeluppi
- Dipartimento Attività Integrata di Medicine, Medicina d'Urgenza e Specialità Mediche, Malattie infettive, Università di Modena e Reggio Emilia, Modena, Italy
| | - M Luppi
- Dipartimento Attività Integrata di Oncologia, Ematologia e Patologie dell'Apparato Respiratorio, Ematologia, Azienda Ospedaliero-Universitaria Policlinico, Università di Modena e Reggio Emilia, Modena, Italy
| | - C Mussini
- Dipartimento Attività Integrata di Medicine, Medicina d'Urgenza e Specialità Mediche, Malattie infettive, Università di Modena e Reggio Emilia, Modena, Italy
| | - M Girardis
- Divisione di Anestesiologia e Terapia Intensiva, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Elisabetta Blasi
- Dipartimento di Medicina Diagnostica, Clinica e di Sanità Pubblica, Istituti Biologici, Università di Modena e Reggio Emilia, Via Campi 287, 41125, Modena, Italy.
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Epidemiology, clinical characteristics, and outcome of candidemia in a tertiary referral center in Italy from 2010 to 2014. Infection 2015; 44:205-13. [DOI: 10.1007/s15010-015-0845-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/15/2015] [Indexed: 12/26/2022]
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Martínez-Jiménez MC, Muñoz P, Valerio M, Vena A, Guinea J, Bouza E. Combination of Candida biomarkers in patients receiving empirical antifungal therapy in a Spanish tertiary hospital: a potential role in reducing the duration of treatment. J Antimicrob Chemother 2015; 70:3107-15. [PMID: 26311840 DOI: 10.1093/jac/dkv241] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 07/13/2015] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Initiation of empirical antifungal therapy for invasive candidiasis (IC) is usually based on clinical suspicion. Serological biomarkers have not yet been studied as a means of ruling out IC. We evaluated the potential role of two combined biomarkers in stopping unnecessary antifungals in patients at risk of IC in the ICU and in other wards. METHODS This was a prospective observational study including adults starting empirical antifungal treatment for suspected IC, at Gregorio Marañón Hospital, Madrid (Spain). Patients were stratified according to admission department (ICU or other wards) and final diagnosis (no IC or proven or probable IC). Type of candidiasis (candidaemia or deep-seated candidiasis) was also considered. The Candida albicans germ tube antibody (CAGTA) test and the β-d-glucan (BDG) test were performed on serum samples collected by venepuncture on days 0, 3 and 5 after starting empirical antifungal therapy. RESULTS Sixty-three ICU patients and 37 non-ICU patients were included. High-risk gastrointestinal surgery and sepsis in non-surgical patients were the main indications for empirical treatment (30% each). Patients had no IC (58%), proven IC (30%) or probable IC (12%). Overall, sensitivity and negative predictive value of the combination of both the CAGTA test and the BDG test were 97% for the entire population. The best performance was observed in ICU patients (sensitivity and negative predictive value of 100%). Among patients without IC, all biomarkers were negative in 31 patients. CONCLUSIONS Serial determination of CAGTA/BDG during empirical antifungal therapy has a high sensitivity and negative predictive value. If properly confirmed, this strategy could be used to discontinue antifungal treatment in at least 31% of patients as a complementary tool in antifungal stewardship programmes.
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Affiliation(s)
- M Carmen Martínez-Jiménez
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Maricela Valerio
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - Antonio Vena
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - Jesús Guinea
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Emilio Bouza
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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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. [PMID: 26077083 DOI: 10.1007/s00134-015-3892-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
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Bassetti M, Leon C, Timsit JF. Are prophylactic antifungals in highly colonized patients safe and effective? Intensive Care Med 2015; 41:1336-9. [PMID: 26077079 DOI: 10.1007/s00134-015-3888-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 05/15/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy,
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Bassetti M, Merelli M, Ansaldi F, de Florentiis D, Sartor A, Scarparo C, Callegari A, Righi E. Clinical and therapeutic aspects of candidemia: a five year single centre study. PLoS One 2015; 10:e0127534. [PMID: 26010361 PMCID: PMC4444310 DOI: 10.1371/journal.pone.0127534] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/16/2015] [Indexed: 11/18/2022] Open
Abstract
Background Candida is an important cause of bloodstream infections (BSI) in nosocomial settings causing significant mortality and morbidity. This study was performed to evaluate contemporary epidemiology, species distribution, antifungal susceptibility and outcome of candida BSI in an Italian hospital. Methods All consecutive patients who developed candidemia at Santa Maria della Misericordia University Hospital (Italy) between January 2009 and June 2014 were enrolled in the study. Results A total of 204 episodes of candidemia were identified during the study period with an incidence of 0.79 episodes/1000 admissions. C. albicans was isolated in 60.3% of cases, followed by C. parapsilosis (16.7%), C. glabrata (11.8%) and C. tropicalis (6.4%). Of all Candida BSI, 124 (60.8 %) occurred in patients admitted to IMW, 31/204 (15.2 %) in ICUs, 33/204 (16.2%) in surgical units and 16/204 (7.8%) in Hematology/Oncology wards. Overall, 47% of patients died within 30 days from the onset of candidemia. C. parapsilosis and C. glabrata candidemia were associated with the lowest mortality rate (36%), while patients with C. tropicalis BSI had the highest mortality rate (58.3%). Lower mortality rates were detected in patients receiving therapy within 48 hours from the time of execution of the blood cultures (57,1% vs 38,9%, P <0.05). At multivariate analysis, steroids treatment (OR= 0.27, p=0.005) and CVC removal (OR=3.77, p=0.014) were independently associated with lower and higher survival probability, respectively. Candidemia in patients with peripherally inserted central catheters (PICC) showed to be associated with higher mortality in comparison with central venous catheters (CVC, Short catheters and Portacath) and no CVC use. For each point increase of APACHE III score, survival probability decreased of 2%. Caspofungin (OR=3.45, p=0.015) and Amphothericin B lipid formulation (OR=15.26, p=0.033) were independently associated with higher survival probability compared with no treatment.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
- * E-mail:
| | - Maria Merelli
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Filippo Ansaldi
- IRCCS San Martino IST, Department of Health Sciences, University of Genoa; Genoa, Italy
| | | | - Assunta Sartor
- Microbiology Unit, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Claudio Scarparo
- Microbiology Unit, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Astrid Callegari
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
| | - Elda Righi
- Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy
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