title: Epidemiology and outcome of candidemia in internal medicine wards: A regional study in Italy.
abstract: BACKGROUND
  More than one-third of candidemia episodes occur in Internal Medicine Wards (IMWs) but only few studies have focused on this setting and specific data about epidemiology, clinical characteristics and risk factors for mortality are scant.
  
  
  OBJECTIVE
  To describe epidemiology and to assess risk factors for in-hospital mortality among patients with candidemia in IMWs.
  
  
  METHODS
  Multicenter retrospective cohort study on patients with candidemia cared for in IMWs of an Italian region (Emilia Romagna) from January 2012 to December 2013. Non survivors were compared with survivors; variables with p≤0.1 at univariate analysis were entered into a multivariate Cox regression model.
  
  
  RESULTS
  232 patients were included. Overall candidemia incidence was 2.2 cases/1000 admissions. Candida albicans accounted for 59% of cases. Antifungal treatment was started <24h, 24-72h, and >72h from blood cultures in 47%, 27% and 12% of patients, respectively; 13.8% of patients received no antifungal treatment. In-hospital mortality was 40%. At multivariate analysis, chronic-obstructive-pulmonary-disease (HR 2.72, 95%CI 1.66-4.45, p<0.001) and isolation of C. tropicalis (HR 2.18, 95%CI 1.19-3.99, p=0.01) were the independent risk factors for in-hospital mortality; central-venous-catheter removal (HR 0.59, 95%CI 0.36-0.96, p=0.03) and adequate and timely (within 72h from blood drawing) empirical therapy (HR 0.42, 95%CI 0.25-0.69, p=0.001) were protective factors.
  
  
  CONCLUSIONS
  The present study conducted in a relatively large geographic area confirms high incidence and mortality of candidemia in IMWs, with a worrisome rate of inappropriateness in patient management. Specific interventions aimed to increase awareness of IMWs about candidemia are needed.
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy. Electronic address: sara.tedeschi@aosp.bo.it.
authors.forename: Sara
authors.initials: S
authors.lastname: Tedeschi
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Tumietto
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Giannella
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Bartoletti
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cristini
authors.affiliation: Internal Medicine Unit, Hospital of Pavullo nel Frignano, Modena, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Cioni
authors.affiliation: Clinical Microbiology Unit, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Ambretti
authors.affiliation: Microbiology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Carretto
authors.affiliation: Microbiology Unit, Hub Laboratory AUSL della Romagna, Pievesestina, Forlì-Cesena, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Sambri
authors.affiliation: Clinical Microbiology Unit, S. Agostino-Estense Hospital, Baggiovara, Modena, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Sarti
authors.affiliation: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Viale
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D002176:Candida albicans; D058387:Candidemia / Q000188:drug therapy* / Q000401:mortality*; D003428:Cross Infection / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D007388:Internal Medicine; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents
keywords: Antifungal treatment; Candidemia; Epidemiology; Internal medicine wards; Mortality