Epidemiology, microbiology, clinical characteristics, and outcomes of candidemia in internal medicine wards-a retrospective study.
BACKGROUND
The clinical characteristics of internal medicine ward (IMW) patients with candidemia are unclear. The aim of this study was to define the clinical characteristics of candidemic IMW patients and to study the incidence, species distribution, and outcomes of these patients compared to surgical and intensive care unit (ICU) candidemic patients.


METHODS
A retrospective cohort of candidemic patients in IMWs, general surgery wards, and an ICU at Beilinson Hospital during the period 2007-2014 was analyzed.


RESULTS
A total of 118 patients with candidemia were identified in six IMWs, two general surgery wards, and one ICU in the hospital. Candida albicans was the leading causative agent (41.1%). Higher proportions of Candida parapsilosis and Candida tropicalis isolates were observed in the IMW patients. IMW patients were significantly older, with poorer functional capacity, and had more frequently been exposed to antibiotic therapy within 90 days, in particular β-lactam-β-lactamase inhibitor combinations and cephalosporins. At onset of candidemia, a significantly lower number of IMW patients were mechanically ventilated (p<0.01); these patients did not have central line catheters comparable to ICU and surgical patients (p<0.001). They were less likely to receive adequate antifungal therapy within 48h, and this was the only significant predictor of survival in these patients (p=0.028): hazard ratio 3.7 (95% confidence interval 1.14-12.5) for therapy delayed to >48h.


CONCLUSIONS
IMW candidemic patients account for a substantial proportion of candidemia cases and have unique characteristics and high mortality rates.
Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel. Electronic address: noaeliakim@gmail.com.
Noa
N
Eliakim-Raz
Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; Department of Urology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
Roi
R
Babaoff
Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Dafna
D
Yahav
Department of Internal Medicine D, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
Shirly
S
Yanai
Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Hila
H
Shaked
Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Jihad
J
Bishara
D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000302:isolation & purification; D002176:Candida albicans / Q000187:drug effects; D041022:Candida tropicalis / Q000187:drug effects; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology; D002511:Cephalosporins / Q000627:therapeutic use; D005260:Female; D006757:Hospital Units; D006801:Humans; D015994:Incidence; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D065093:beta-Lactamase Inhibitors / Q000627:therapeutic use
D000935:Antifungal Agents; D002511:Cephalosporins; D065093:beta-Lactamase Inhibitors
Candida species; Candidemia; Internal medicine ward