Clinical characteristics, management and outcome of patients with invasive candidiasis hospitalized in Internal Medicine
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ORIGINAL PAPER
Clinical characteristics, management and outcome of patients with invasive candidiasis hospitalized in Internal Medicine Units: findings from a registry by the Italian Scientific Society FADOI F. Pieralli1 · F. Dentali2 · M. Giusti3 · T. Ciarambino4 · A. Mazzone5 · E. Concia6 · M. Sanguinetti7 · M. G. Nallino8 · I. Morana9 · C. Santini10 · G. Gussoni11 · E. Zagarrì11 · D Manfellotto12 · FADOI—IFI Registry Group Received: 6 July 2020 / Accepted: 1 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Invasive candidiasis (IC) is a challenging clinical condition, burdened by relevant mortality and morbidity. There is limited knowledge on the occurrence and management of IC in Internal Medicine Units (IMUs). Aim of this study was to provide real-world data on this topic. Methods Consecutive objectively diagnosed cases of IC were collected in this prospective registry, which involved 18 IMUs in Italy. Patients were followed-up to 90 days from the diagnosis of candidemia. Results A total of 111 patients were observed (median age 78, IQR 67–83) for an overall incidence of infection of 1.89 cases/1000 hospital admissions. Candida albicans was the most frequent isolated species (62%), followed by Candida parapsilosis (17%) and Candida glabrata (13%). Echinocandins and fluconazole were used as initial therapy in 56.8 and 43.2% of patients, respectively. Antifungal therapy was started within 24 h in 18.9% of patients, in 40.6% in the period 1–3 days, and in 40.5% of patients more than 3 days after blood cultures. Death rate was 19.8% at 30 days and 40.5% at 90 days. At multivariable analysis concomitant bacteremia (i.e. polymicrobial sepsis), and fluconazole as the initial therapy were associated with an increased risk of death at 90 days. Conclusions The incidence of IC is not negligible, and our registry confirmed that these patients have a relevant mortality rate at 90 days. Concomitant bacteremia, featuring polymicrobial sepsis, and starting antifungal treatment with fluconazole instead of echinocandins independently increase the risk of death. Efforts are needed to improve the awareness and management of IC in IMUs. Keywords Invasive candidiasis · Candida · Infection · Registry · Internal Medicine Units
* E. Zagarrì [email protected] 1
Internal Medicine Department, Careggi Hospital, Florence, Italy
2
Internal Medicine Department, Insubria University, Varese, Italy
3
Internal Medicine Department, San Giovanni Bosco Hospital, Turin, Italy
4
Internal Medicine Department, Veneziale Hospital, Isernia, Italy
5
Internal Medicine Department, Ospedale Civile Di Legnano (Milan), Legnano, Italy
6
Department of Infectious Diseases, University of Verona, Verona, Italy
7
Department of Laboratory Sciences & Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
8
Internal Medicine Department, Regina Montis Regalis Hospital, Mondovì, CN, Italy
9
Internal Medicine Department, Garibaldi Hospital, Catania, Ita
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