The Effect on mortality of fluconazole or echinocandins treatment in candidemia in internal medicine wards [corrected].
The incidence of candidemia has increased over the past two decades, with an increased number of cases in Internal Medicine and a prevalence ranging from 24% to 57%. This single-center retrospective study was performed to evaluate the epidemiology and the risk factors associated with mortality of candidemia in patients admitted to Internal Medicine wards (IMWs) of the City of Health and Sciences, Molinette Hospital, Turin, from January 2004 to December 2012. For each patient, demographic, clinical and microbiological data were collected. A case of candidemia was defined as a patient with at least one blood culture positive for Candida spp. Amongst 670 episodes of candidemia, 274 (41%) episodes occurred in IMWs. The mortality was 39% and was associated at multivariate analysis with sepsis, cirrhosis and neurologic diseases, whilst removal of central venous catheter ≤48h was significantly associated with survival. In the 77 patients treated with early antifungal therapy the mortality was 29% and was not significantly different with caspofungin or fluconazole, whilst in patients with definitive therapy the mortality was significantly lower with echinocandins compared to fluconazole (11.7% Vs. 39%; p=0.0289), a finding confirmed by multivariate analysis. The mortality was significantly associated with sepsis, cirrhosis and neurologic diseases, whilst CVC removal ≤48h was associated with survival. In patients with early therapy, fluconazole or caspofungin were equally effective. However, echinocandins were significantly more effective as definitive treatment, a finding not explained by differences in treatment delays. Further studies are needed to understand the full potential of these different therapeutic strategies in IMWs.
Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
Francesco G
FG
De Rosa
Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
Silvia
S
Corcione
Department of Anesthesia and Critical Care, City of Health and Sciences, Molinette Hospital, University of Turin, Turin, Italy.
Claudia
C
Filippini
Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
Stefania
S
Raviolo
Department of Public Health and Pediatric Sciences, Laboratory of Microbiology and Virology, City of Health and Sciences, Molinette, University of Turin, Turin, Italy.
Lucina
L
Fossati
Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
Chiara
C
Montrucchio
Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
Chiara
C
Aldieri
Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
Alessia
A
Petrolo
Department of Public Health and Pediatric Sciences, Laboratory of Microbiology and Virology, City of Health and Sciences, Molinette, University of Turin, Turin, Italy.
Rossana
R
Cavallo
Department of Medical Sciences, Infectious Diseases at Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
Giovanni
G
Di Perri
D000368:Aged; D058387:Candidemia / Q000188:drug therapy* / Q000401:mortality*; D054714:Echinocandins / Q000627:therapeutic use*; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010362:Patients' Rooms / Q000706:statistics & numerical data*; D012307:Risk Factors
D054714:Echinocandins; D015725:Fluconazole