title: Epidemiology and outcome of nosocomial candidemia in elderly patients admitted prevalently in medical wards.
abstract: OBJECTIVE
  Candidemia represents an important cause of morbidity and mortality. To-date, the highest rates of candidemia occur in elderly patients, but there are few data on such patient population. The aims of this study were to evaluate the epidemiology, treatment and outcome of candidemia in an elderly patient population.
  
  
  METHODS
  Nosocomial candidemia episodes occurring in a university general hospital were included in this study. Demographic, clinical, and Candida susceptibility testing data were retrospectively collected. Potential risk factors for 30-day crude mortality rate including host factors, Candida species, concomitant bacteremia, severity of sepsis, and management of fungemia were assessed by hazard risk (HR) analyses.
  
  
  RESULTS
  145 consecutive episodes of candidemia occurring in 140 patients with a median age of 81 years (interquartile range, 78-86 years) were analyzed. At the onset of candidemia, 98 (67.6 %) cases were hospitalized in medical wards. Candida albicans accounted for 55 % of all candidemia episodes. Overall, resistance to fluconazole was detected in 8.0 % of Candida isolates. Crude hospital mortality at 30 days was 46 %. Failure to receive adequate antifungal therapy was the significant risk factor for death on multivariable analysis (adjusted HR 1.87, 95 % CI 0.94-2.79).
  
  
  CONCLUSIONS
  Over two-thirds of elderly patients with candidemia are admitted to medical wards in our series. 30-day crude mortality is high and seems to be related to inadequate antifungal therapy. Increased awareness of the burden of this disease also in medical wards is strongly required to recognize and treat properly this severe infection.
authors.affiliation: Infectious Disease Unit, University Hospital of Trieste, Italy Piazzale Ospitale 1, 34100, Trieste, Italy, roberto.luzzati@aots.sanita.fvg.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Luzzati
authors.forename: Silvia
authors.initials: S
authors.lastname: Cavinato
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Deiana
authors.forename: Chiara
authors.initials: C
authors.lastname: Rosin
authors.forename: Cristina
authors.initials: C
authors.lastname: Maurel
authors.forename: Massimo
authors.initials: M
authors.lastname: Borelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D025141:Drug Resistance, Fungal; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents