title: Mortality in patients with early- or late-onset candidaemia.
abstract: OBJECTIVE
  Although candidaemia is a well-known complication of hospital stay and has a crude mortality of ∼40%, few data are available for episodes diagnosed within 10 days after hospital admission. In this paper, we compared the risk factors for mortality according to the onset of candidaemia.
  
  
  METHODS
  This was a retrospective study of hospitalized patients with early-onset candidaemia (EOC; ≤ 10 days) or late-onset candidaemia (LOC; >10 days) to identify any distinct clinical characteristics and risk factors for 30 day mortality in two Italian academic centres.
  
  
  RESULTS
  A total of 779 patients were included in the study: 183 EOC and 596 LOC. Mortality was significantly lower in EOC (71/183, 38.8% versus 283/596, 47.5%, P=0.03). In EOC, multivariate analysis showed that inadequate initial antifungal therapy (IIAT) (P=0.005, OR 3.02, 95% CI 1.40-6.51), Candida albicans aetiology (P=0.02, OR 2.17, 95% CI 1.11-4.26) and older age (P<0.001, OR 1.05, 95% CI 1.02-1.07) were independent risk factors for mortality. In LOC, liver disease (P=0.003, OR 2.46, 95% CI 1.36-4.43), IIAT (P=0.002, OR 2.01, 95% CI 1.28-3.15) and older age (P<0.001, OR 1.03, 95% CI 1.02-1.04) were independently associated with a fatal outcome, while treatment with caspofungin was associated with survival (P<0.001, OR 0.42, 95% CI 0.26-0.67).
  
  
  CONCLUSIONS
  EOC has different clinical characteristics and risk factors for mortality compared with LOC. Although EOC mortality is significantly lower, the rate of inappropriate antifungal treatment is higher. Treatment with caspofungin is significantly associated with survival in patients with LOC. Efforts are needed to improve the diagnosis and treatment of EOC.
authors.affiliation: Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy. francescogiuseppe.derosa@unito.it
authors.forename: Francesco Giuseppe
authors.initials: FG
authors.lastname: De Rosa
authors.forename: Enrico Maria
authors.initials: EM
authors.lastname: Trecarichi
authors.forename: Chiara
authors.initials: C
authors.lastname: Montrucchio
authors.forename: Angela Raffaella
authors.initials: AR
authors.lastname: Losito
authors.forename: Stefania
authors.initials: S
authors.lastname: Raviolo
authors.forename: Brunella
authors.initials: B
authors.lastname: Posteraro
authors.forename: Silvia
authors.initials: S
authors.lastname: Corcione
authors.forename: Simona
authors.initials: S
authors.lastname: Di Giambenedetto
authors.forename: Lucina
authors.initials: L
authors.lastname: Fossati
authors.forename: Maurizio
authors.initials: M
authors.lastname: Sanguinetti
authors.forename: Roberto
authors.initials: R
authors.lastname: Serra
authors.forename: Roberto
authors.initials: R
authors.lastname: Cauda
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Perri
authors.forename: Mario
authors.initials: M
authors.lastname: Tumbarello
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D058387:Candidemia / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology; D003428:Cross Infection / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors