title: Epidemiology, clinical characteristics, and outcome of candidemia in a tertiary referral center in Italy from 2010 to 2014.
abstract: OBJECTIVE
  We evaluated the epidemiology, clinical characteristics and outcome of candidemia in a single institution from 2010 to 2014.
  
  
  METHODS
  A retrospective observational study of all cases of candidemia was carried out at a University Hospital in Central Italy including five intensive care units (ICUs), 11 medical and 11 surgical wards. Data regarding demographic characteristics and clinical risk factors were collected from the patient's medical records. Antifungal susceptibility testing was performed and MIC results were interpreted according to species-specific clinical breakpoints.
  
  
  RESULTS
  A total of 270 episodes of candidemia were identified. Overall incidence rate was 1.5 episodes/1000 hospital admissions. Although Candida albicans represented the most commonly isolated species, its percentage significantly decreased from 68 to 48 % (p = 0.040). The overall 30-day mortality was 35 %. The variables independently associated with a significant higher risk of mortality were: older age; being hospitalized in ICU or in medical wards vs surgical wards; being infected with C. albicans vs other species; the occurrence of septic shock, pneumonia and acute renal failure; the presence of a solid organ tumor or a chronic pulmonary disease. Conversely, an appropriate treatment was confirmed to be significantly associated with a lower risk of mortality. The overall resistance was low and it was noted only among triazoles.
  
  
  CONCLUSIONS
  Our study shows that candidemia is a significant source of morbidity and mortality. The identification of risk factors associated with mortality along with the knowledge of local susceptibility may lead to a better management in terms of preventive and therapeutic measures.
authors.affiliation: Dipartimento di Scienze Biomediche e Sanità Pubblica, Clinica Malattie Infettive, Università Politecnica delle Marche, Ancona, Italy. f.barchiesi@univpm.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Barchiesi
authors.affiliation: Dipartimento di Scienze Biomediche e Sanità Pubblica, Clinica Malattie Infettive, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Orsetti
authors.affiliation: Dipartimento di Scienze Biomediche e Sanità Pubblica, Centro di Epidemiologia e Biostatistica, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Rosaria
authors.initials: R
authors.lastname: Gesuita
authors.affiliation: Dipartimento di Scienze Biomediche e Sanità Pubblica, Centro di Epidemiologia e Biostatistica, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Edlira
authors.initials: E
authors.lastname: Skrami
authors.affiliation: Laboratorio di Microbiologia, Azienda Ospedaliera-Universitaria Umberto I°-Lancisi-Salesi, Ancona, Italy.
authors.forename: Esther
authors.initials: E
authors.lastname: Manso
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002175:Candida / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents
keywords: Antifungal susceptibility testing; Candida albicans; Candida species; Candidemia; Mortality