1
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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)
| | | |
Collapse
|