Candidemia In Internal Medicine Wards (iIMW): Epidemiology, Time to Initiate Antifungal Treatment and Outcome

Ref ID: 18713

Author:

M. Bassetti, MD, PhD – Professor1, E. Righi, MD – Professor 1, E. Nicco, MD – assistant 2, L. Taramasso, MD – assistant 2, C. Viscoli, MD – Professor 2;

Author address:

1Santa Maria Misericordia Hosp., Udine, Italy, 2San Martino Hosp., Genova, Italy.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: Candidemia affects patient populations especially in intensive care and surgical units. Very little information is available about the epidemiology of candidemia in IMW. Methods: We performed a retrospective analysis of 348 episodes of candidemia in adults from the electronic database of a 1,500-bed tertiary care hospital in Italy. Demographics, underlying diseases, comorbidities, species, treatment, time to initiate antifungal treatment and outcome were compared between the patients admitted to the IMW and other wards. Univariate and multivariate analyses were performed to identify factors associated with mortality and treatment success. Results: From January 2008 to December 2010, 38 % (133/348) of the patients with candidemia were admitted to IMW. Variables that were observed significantly more frequently in this setting compared to other wards included length of hospitalization > 30 days, receipt of antibiotics, urinary catheter, renal failure, solid tumor, and age > 75 yo. The 30-day mortality of IMW patients was significantly higher than that of patients in other wards (51.1% vs. 38.2%, p<0.02). From the time that the first positive blood sample for culture was drawn, 3 (2%) patients received appropriate antifungal treatment within 24 hours (h), 7 (5 %) patients received antifungal treatment between 24 and 48 h, 15 (11%) patients received antifungal treatment between 48 and 72 h, and 91 (69%) patients received antifungal treatment after 72 h. Of note, 17 (13%) patients did not receive any antifungal treatment. Multiple logistic regression analysis identified the administration of antifungal treatment 48 h after having the first positive blood sample for culture (OR=12.3636 (95% CI 1.5351-99.5767, p=0.0017) as an independent determinant of hospital mortality. Conclusions: IMW patients account for a substantial proportion of patients with candidemia and have a higher mortality compared to patients admitted to other wards. Early administration within 48 h of adequate antifungal therapy improves survival among patients with candidemia in IMW.

Abstract Number: M-317

Conference Poster: y

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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