title: The epidemiology, antifungal use and risk factors of death in elderly patients with candidemia: a multicentre retrospective study.
abstract: BACKGROUND
  The elderly patients affected by candidemia are growing in proportion to inpatients, but available data are limited. We aimed to determine the epidemiology, antifungal management and clinical risk factors of death in the elderly population with candidemia in China.
  
  
  METHODS
  This retrospective study included 63 elderly (≥65 years) and 84 younger patients (16-60 years) at 4 tertiary hospitals. Multivariable logistic regression model was used to identify independent risk factors of death in elderly patients.
  
  
  RESULTS
  The distribution of Candida species did not differ between elderly and younger patients (p >0.05). Resistance to fluconazole and voriconazole for non-Candida albicans species in elderly patients was approximately double that in younger patients. Host-related risk factors (e.g., underlying solid tumour, diabetes mellitus and chronic renal failure) and hospital-related factors (e.g., prior stay in an intensive care unit, mechanical ventilation, central vascular and urethral catheters placement) were identified more common in elderly patients. Elderly patients less often received triazoles and were less likely to receive antifungal therapies mostly because elderly or their guardians quit antifungal therapies. APACHE II scores and 30-day mortality were higher for elderly than younger patients (31.7% vs. 16.7%, p =0.032). For elderly patients, antifungal therapy administered before microbiological documentation was the only protective factor for death, whereas absence of antifungal therapies, receipt of mechanical ventilation and APACHE II score ≥20 were independent predictors of death.
  
  
  CONCLUSIONS
  Elderly patients with candidemia had poor prognoses characterized by certain host and hospital-related risk factors and special pathogen resistance features. More awareness of the burden of this disease is required, and the absence of antifungal therapies should be avoided to improve the prognoses of elderly patients with this severe infection.
authors.affiliation: Department of Critical Care Medicine, Qilu Hospital, Shandong University, 107 Wenhua-xi Road, Jinan, 250012, Shandong, China. wanghao34@126.com.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Emergency, Liaocheng People's Hospital affiliated with Taishan Medical College, 67 Dongchang-xi Road, Liaocheng, Shandong, 252000, China. 13375601828@163.com.
authors.forename: Naizheng
authors.initials: N
authors.lastname: Liu
authors.affiliation: Department of Geriatrics, Qilu Hospital, Shandong University, 107 Wenhua-xi Road, Jinan, Shandong, 250012, China. sdyinmei@eyou.com.
authors.forename: Mei
authors.initials: M
authors.lastname: Yin
authors.affiliation: Department of Critical Care Medicine, Qilu Hospital, Shandong University, 107 Wenhua-xi Road, Jinan, 250012, Shandong, China. 920052035@qq.com.
authors.forename: Hui
authors.initials: H
authors.lastname: Han
authors.affiliation: Department of Critical Care Medicine, Qilu Hospital, Shandong University, 107 Wenhua-xi Road, Jinan, 250012, Shandong, China. 187191665@qq.com.
authors.forename: Jinfeng
authors.initials: J
authors.lastname: Yue
authors.affiliation: Department of Critical Care Medicine, Qilu Hospital, Shandong University, 107 Wenhua-xi Road, Jinan, 250012, Shandong, China. 61371543@qq.com.
authors.forename: Fan
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Department of Critical Care Medicine, Qilu Hospital, Shandong University, 107 Wenhua-xi Road, Jinan, 250012, Shandong, China. smilethis@126.com.
authors.forename: Tichao
authors.initials: T
authors.lastname: Shan
authors.affiliation: Department of Critical Care Medicine, Qilu Hospital, Shandong University, 107 Wenhua-xi Road, Jinan, 250012, Shandong, China. woreme@sina.com.
authors.forename: Haipeng
authors.initials: H
authors.lastname: Guo
authors.affiliation: Department of Critical Care Medicine, Qilu Hospital, Shandong University, 107 Wenhua-xi Road, Jinan, 250012, Shandong, China. shandongicu@gmail.com.
authors.forename: Dawei
authors.initials: D
authors.lastname: Wu
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006299:Health Services for the Aged; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole; D065819:Voriconazole