Assessment of risk factors for candidemia in non-neutropenic patients hospitalized in Internal Medicine wards: A multicenter study.
BACKGROUND
An increasing prevalence of candidemia has been reported in Internal Medicine wards (IMWs). The aim of our study was to identify risk factors for candidemia among non-neutropenic patients hospitalized in IMWs.


METHODS
A multicenter case-control study was performed in three hospitals in Italy. Patients developing candidemia (cases) were compared to patients without candidemia (controls) matched by age, time of admission and duration of hospitalization. A logistic regression analysis identified risk factors for candidemia, and a new risk score was developed. Validation was performed on an external cohort of patients.


RESULTS
Overall, 951 patients (317 cases of candidemia and 634 controls) were included in the derivation cohort, while 270 patients (90 patients with candidemia and 180 controls) constituted the validation cohort. Severe sepsis or septic shock, recent Clostridium difficile infection, diabetes mellitus, total parenteral nutrition, chronic obstructive pulmonary disease, concomitant intravenous glycopeptide therapy, presence of peripherally inserted central catheter, previous antibiotic therapy and immunosuppressive therapy were factors independently associated with candidemia. The new risk score showed good area under the curve (AUC) values in both derivation (AUC 0.973 95% CI 0.809-0.997, p<0.001) and validation cohort (0.867 95% CI 0.710-0.931, p<0.001). A threshold of 3 leads to a sensitivity of 87% and a specificity of 83%.


CONCLUSIONS
Non-neutropenic patients admitted in IMWs have peculiar risk factors for candidemia. A new risk score with a good performance could facilitate the identification of candidates to early antifungal therapy.
Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy. Electronic address: marco.falcone@uniroma1.it.
M
M
Falcone
Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Italy.
G
G
Tiseo
Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
C
C
Tascini
Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy.
A
A
Russo
Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
E
E
Sozio
Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy.
G
G
Raponi
University Hospital of Trieste, Trieste, Italy.
C
C
Rosin
Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Italy.
P
P
Pignatelli
San Giovanni Addolorata Hospital, Rome, Italy.
P
P
Carfagna
Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy.
A
A
Farcomeni
University Hospital of Trieste, Trieste, Italy.
R
R
Luzzati
Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Italy.
F
F
Violi
Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
F
F
Menichetti
Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy.
M
M
Venditti
D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology*; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007388:Internal Medicine; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors
D000935:Antifungal Agents
Candidemia; Clostridium difficile infection; Internal Medicine; Non-neutropenic patients; Risk factors; Sepsis