title: Nosocomial candidemia in patients admitted to medicine wards compared to other wards: a multicentre study.
abstract: OBJECTIVE
  Risk factors for nosocomial candidemia, severity of sepsis, treatment, and outcome were compared between patients admitted to medicine wards and those to surgical and intensive care units (ICUs).
  
  
  METHODS
  Data were retrospectively collected from patients belonging to six referral hospitals in Italy between January 2011 and December 2013. Risk factors for 30-day mortality were evaluated in the whole patient population.
  
  
  RESULTS
  A total of 686 patients (mean age 70 ± 15 years) with candidemia were included. 367 (53.5 %) patients were in medicine wards, and 319 in surgery and ICUs. Host-related risk factors for candidemia were more common in medicine patients whereas healthcare-related factors in surgery/ICU patients. These patients showed severe sepsis and septic shock more commonly (71.7 %) than medicine patients (59.9 %) (p 0.003). The latter underwent central venous catheter (CVC) removal and adequate antifungal therapy less frequently than surgery/ICU patients. 149 (40.6 %) patients died with candidemia in medicine wards and 69 (21.6 %) in other wards (p < 0.001). Overall, the 30-day mortality was 36.3 %. At multivariate analysis, independent risk factors for death were aging, higher Charlson score, severe sepsis and septic shock, and no antifungal therapy, while major surgery and CVC removal were associated with higher probability of survival.
  
  
  CONCLUSIONS
  The burden of risk factors for candidemia was different between medicine patients and those in other wards. Despite the lower severity of candidemia in medicine patients, their mortality turned out to be higher than in surgery or ICU patients. Awareness of the best management of candidemia should be pursued, especially in medicine wards.
authors.affiliation: Infectious Disease Unit, University Hospital of Trieste, Piazzale dell' Ospitale 2, 34125, Trieste, Italy. roberto.luzzati@asuits.sanita.fvg.it.
authors.forename: Roberto
authors.identifier: http://orcid.org/0000-0001-5546-0715
authors.initials: R
authors.lastname: Luzzati
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, 33010, Udine, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Merelli
authors.affiliation: Department of Health Sciences, IRCCS San Martino IST, Largo R. Benzi 10, 16132, Genoa, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Ansaldi
authors.affiliation: Infectious Disease Unit, University Hospital of Trieste, Piazzale dell' Ospitale 2, 34125, Trieste, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Rosin
authors.affiliation: Infectious Diseases Division, University Hospital, Piazzale L. Scuro 10, 37134, Verona, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Azzini
authors.affiliation: Infectious and Tropical Diseases Division, University Hospital, Via N. Giustiniani 2, 35128, Padua, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Cavinato
authors.affiliation: Infectious Diseases Division, Hospital of Venice, Castello 6777, 30122, Venice, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Brugnaro
authors.affiliation: Infectious Diseases Division, Hospital of Bolzano, Via L. Bohler 5, 39100, Bolzano, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Vedovelli
authors.affiliation: Infectious and Tropical Diseases Division, University Hospital, Via N. Giustiniani 2, 35128, Padua, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Cattelan
authors.affiliation: Laboratory for Microbiology, University Hospital, Strada di Fiume 447, 34149, Trieste, Italy.
authors.forename: Busetti
authors.initials: B
authors.lastname: Marina
authors.affiliation: Division of Cardiac Surgery, University Hospital, Via P. Valdoni 7, 34148, Trieste, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gatti
authors.affiliation: Infectious Diseases Division, University Hospital, Piazzale L. Scuro 10, 37134, Verona, Italy.
authors.forename: Ercole
authors.initials: E
authors.lastname: Concia
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, 33010, Udine, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bassetti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058387:Candidemia / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006757:Hospital Units; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Candidemia; Elderly; Epidemiology; Medicine wards; Mortality; Risk factors