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Epidemiology and outcome of nosocomial candidemia in elderly patients admitted prevalently in medical wards

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Abstract

Background and aims

Candidemia represents an important cause of morbidity and mortality. To-date, the highest rates of candidemia occur in elderly patients, but there are few data on such patient population. The aims of this study were to evaluate the epidemiology, treatment and outcome of candidemia in an elderly patient population.

Methods

Nosocomial candidemia episodes occurring in a university general hospital were included in this study. Demographic, clinical, and Candida susceptibility testing data were retrospectively collected. Potential risk factors for 30-day crude mortality rate including host factors, Candida species, concomitant bacteremia, severity of sepsis, and management of fungemia were assessed by hazard risk (HR) analyses.

Results

145 consecutive episodes of candidemia occurring in 140 patients with a median age of 81 years (interquartile range, 78–86 years) were analyzed. At the onset of candidemia, 98 (67.6 %) cases were hospitalized in medical wards. Candida albicans accounted for 55 % of all candidemia episodes. Overall, resistance to fluconazole was detected in 8.0 % of Candida isolates. Crude hospital mortality at 30 days was 46 %. Failure to receive adequate antifungal therapy was the significant risk factor for death on multivariable analysis (adjusted HR 1.87, 95 % CI 0.94–2.79).

Discussion and conclusions

Over two-thirds of elderly patients with candidemia are admitted to medical wards in our series. 30-day crude mortality is high and seems to be related to inadequate antifungal therapy. Increased awareness of the burden of this disease also in medical wards is strongly required to recognize and treat properly this severe infection.

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Ethical standards

The authors state that the study was approved by the local institutional review board (Comitato Etico per la Sperimentazione, Azienda Ospedaliero-Universitaria di Trieste, Italy) and has therefore been performed in accordance with ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The written consent of patients was not required because of the observational design of this study.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Infectious Disease Unit, University Hospital of Trieste, Italy Piazzale Ospitale 1, 34100, Trieste, Italy

    Roberto Luzzati, Silvia Cavinato, Chiara Rosin & Cristina Maurel

  2. Laboratory of Microbiology, University Hospital of Trieste, Trieste, Italy

    Maria Luisa Deiana

  3. Department of Mathematics and Informatics, University of Trieste, Trieste, Italy

    Massimo Borelli

Authors
  1. Roberto Luzzati
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  2. Silvia Cavinato
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  3. Maria Luisa Deiana
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  4. Chiara Rosin
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  5. Cristina Maurel
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  6. Massimo Borelli
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Corresponding author

Correspondence to Roberto Luzzati.

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Luzzati, R., Cavinato, S., Deiana, M.L. et al. Epidemiology and outcome of nosocomial candidemia in elderly patients admitted prevalently in medical wards. Aging Clin Exp Res 27, 131–137 (2015). https://doi.org/10.1007/s40520-014-0251-x

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  • DOI: https://doi.org/10.1007/s40520-014-0251-x

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