title: Clinical and therapeutic aspects of candidemia: a five year single centre study.
abstract: BACKGROUND
  Candida is an important cause of bloodstream infections (BSI) in nosocomial settings causing significant mortality and morbidity. This study was performed to evaluate contemporary epidemiology, species distribution, antifungal susceptibility and outcome of candida BSI in an Italian hospital.
  
  
  METHODS
  All consecutive patients who developed candidemia at Santa Maria della Misericordia University Hospital (Italy) between January 2009 and June 2014 were enrolled in the study.
  
  
  RESULTS
  A total of 204 episodes of candidemia were identified during the study period with an incidence of 0.79 episodes/1000 admissions. C. albicans was isolated in 60.3% of cases, followed by C. parapsilosis (16.7%), C. glabrata (11.8%) and C. tropicalis (6.4%). Of all Candida BSI, 124 (60.8 %) occurred in patients admitted to IMW, 31/204 (15.2 %) in ICUs, 33/204 (16.2%) in surgical units and 16/204 (7.8%) in Hematology/Oncology wards. Overall, 47% of patients died within 30 days from the onset of candidemia. C. parapsilosis and C. glabrata candidemia were associated with the lowest mortality rate (36%), while patients with C. tropicalis BSI had the highest mortality rate (58.3%). Lower mortality rates were detected in patients receiving therapy within 48 hours from the time of execution of the blood cultures (57,1% vs 38,9%, P < 0.05). At multivariate analysis, steroids treatment (OR = 0.27, p = 0.005) and CVC removal (OR = 3.77, p = 0.014) were independently associated with lower and higher survival probability, respectively. Candidemia in patients with peripherally inserted central catheters (PICC) showed to be associated with higher mortality in comparison with central venous catheters (CVC, Short catheters and Portacath) and no CVC use. For each point increase of APACHE III score, survival probability decreased of 2%. Caspofungin (OR = 3.45, p = 0.015) and Amphothericin B lipid formulation (OR = 15.26, p = 0.033) were independently associated with higher survival probability compared with no treatment.
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bassetti
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Merelli
authors.affiliation: IRCCS San Martino IST, Department of Health Sciences, University of Genoa; Genoa, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Ansaldi
authors.affiliation: USMAF, Ministry of Health, Genova, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: de Florentiis
authors.affiliation: Microbiology Unit, Santa Maria Misericordia University Hospital, Udine, Italy.
authors.forename: Assunta
authors.initials: A
authors.lastname: Sartor
authors.affiliation: Microbiology Unit, Santa Maria Misericordia University Hospital, Udine, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Scarparo
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.
authors.forename: Astrid
authors.initials: A
authors.lastname: Callegari
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.
authors.forename: Elda
authors.initials: E
authors.lastname: Righi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D002175:Candida / Q000187:drug effects / Q000502:physiology; D058387:Candidemia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D010362:Patients' Rooms; D012307:Risk Factors; D017741:Survivors
chemical_list: D000935:Antifungal Agents