Epidemiology and outcome of candidemia in internal medicine wards: A regional study in Italy

Tedeschi, Sara; Tumietto, Fabio; Giannella, Maddalena; Bartoletti, Michele; Cristini, Francesco; Cioni, G; Ambretti, Simone; Carretto, Edoardo; Sambri, Vittorio; Sarti, Mario; Viale, Pierluigi

doi:10.1016/j.ejim.2016.08.020

Cited by 40 publications

(49 citation statements)

References 15 publications

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“…In this study, the overall survival rate on day 30 was 60.4% (treated subjects, 67.4%; not-treated subjects 50.9%), approximately similar to recent reports [21, 33, 34], with an overall mortality rate of 24.8 deaths per 1000 patient-days. In addition, the younger patients in this series had a lower survival rate than that reported by Santolaya et al [35] for a Latin American series evaluating the pediatric patients (60 vs. 72% survival at 30 days.…”

Section: Discussionsupporting

confidence: 91%

“…Furthermore, data from industrialized countries has demonstrated a lower incidence and stable trends for candidemia rates, which are closer to 1.0 case/1000 admissions [6–10]. Recent Italian studies by DeRosa et al [20] and Tedeschi et al [21] reveal an incidence close to the Latin American reports (1.8–2.2/1000 admissions).…”

Section: Discussionmentioning

confidence: 77%

“…Earlier initiation of antifungal therapy has been recognized as a beneficial predictor of survival. [21, 37] No indication of antifungal therapy was associated to early mortality, and also to location of patients (out of ICU, hospitals with lower incidence of candidemia). Increased awareness and an active surveillance are necessary for improving outcomes of patients with candidemia.…”

Section: Discussionmentioning

confidence: 99%

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A multi-centric Study of Candida bloodstream infection in Lima-Callao, Peru: Species distribution, antifungal resistance and clinical outcomes

et al. 2017

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BackgroundThe incidence of candidemia is increasing in developing countries. Very little is known about the epidemiology of candidemia in Peru. The aim of this study is to describe the incidence, microbiology, clinical presentation and outcomes of Candida bloodstream infections in three Lima-Callao hospitals.MethodsCandida spp. isolates were identified prospectively at participant hospitals between November 2013 and January 2015. Susceptibility testing for amphotericin B, fluconazole, posaconazole, voriconazole and anidulafungin was performed using broth microdilution method. Clinical information was obtained from medical records and evaluated.ResultsWe collected information on 158 isolates and 157 patients. Median age of patients was 55.0 yrs., and 64.1% were males. Thirty-eight (24.2%) episodes of candidemia occurred in those <18 yrs. The frequency of non-Candida albicans was 72.1%. The most frequently recovered species were C. albicans (n = 44, 27.8%), C. parapsilosis (n = 40, 25.3%), C. tropicalis (n = 39, 24.7%) and C. glabrata (n = 15, 9.5%). Only four isolates were resistant to fluconazole, 86.7% (n = 137) were susceptible and 17 were susceptible-dose dependent. Decreased susceptibility to posaconazole was also observed in three isolates, and one to voriconazole. All isolates were susceptible to anidulafungin and amphotericin B. The most commonly associated co-morbid conditions were recent surgery (n = 61, 38.9%), mechanical ventilation (n = 60, 38.2%) and total parenteral nutrition (n = 57, 36.3%). The incidence of candidemia by center ranged between 1.01 and 2.63 cases per 1,000 admissions, with a global incidence of 2.04. Only 28.1% of cases received treatment within 72 hrs. of diagnosis. Overall, the 30-day survival was 60.4% (treated subjects, 67.4%; not-treated patients, 50.9%).ConclusionsWe found a very high proportion of non-albicans Candida species. Despite this, the decreased susceptibility/resistance to fluconazole was only 13.3% and not seen in the other antifungals. Overall, the incidence of candidemia mortality was high when compared to other international studies. It is possible, that the delay in initiating antifungal treatment contributed to the elevated mortality rate, in spite of low antifungal resistance.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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A multi-centric Study of Candida bloodstream infection in Lima-Callao, Peru: Species distribution, antifungal resistance and clinical outcomes

et al. 2017

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“…Furthermore, we observed a striking increase in candidaemia among medical patients. These results were confirmed by recent studies performed in both central Italy [22] and Israel [23], in which the authors confirmed the high incidence of candidaemia and related mortality in the internal medicine wards. In the absence of specific data in our study, we can agree with the above-mentioned authors and speculate that patients hospitalized in internal medicine wards are mainly at high risk of developing candidaemia due to higher exposure to antibiotics in the 90 days before the onset of candidaemia, or because of the relatively high incidence of failure to offer adequate and timely effective antifungal therapy.…”

Section: Discussionsupporting

confidence: 80%

Candidaemia in a tertiary care academic hospital in Italy. The impact of C. parapsilosis complex on the species distribution and antifungal susceptibility

Ghezzi

Brunetti

Visconti

et al. 2017

Journal of Medical Microbiology

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Purpose. To analyse the species distribution and the susceptibility profiles to the major antifungal agents of Candida isolated from bloodstream infections (BSIs) in both intensive care units (ICUs) and non-ICU wards in a tertiary care hospital in Italy from 2010 until 2015.Methodology. Episodes of Candida BSI were recorded in a retrospective observational cohort study. Yeasts were isolated from both blood and intravascuIar devices (IVDs) and their susceptibility to antifungal drugs was tested using the microdilution method.Results. 514 Candida BSIs were evidenced and 19 % of these episodes were associated with the presence of an IVD. The trend of the general incidence increased significantly throughout the study period, ranging from 1.42 to 3.63 (mean 2.52) episodes/1000 admissions. The incidence of Candida BSIs and IVD-associated candidaemia was significantly higher in ICUs relative to the other wards. The most frequently isolated species were C. albicans and C. parapsilosis complex, with the latter presenting a significant increased trend of isolation. C. parapsilosis complex was most frequently involved in IVD-related candidaemia, coinfections and late recurrent infections. Furthermore, the MIC 50 s of C. parapsilosis complex were significantly enhanced for echinocandins compared to the MIC 50 s for the same drugs and the other yeasts, while the MIC 50 s of C. albicans for amphotericin B showed a significant increase during the study period, ranging from 0.1 to 0.5 µg ml À1 . Conclusions.A progressively enhanced incidence of Candida BSIs, a relatively high impact of C. parapsilosis complex and changes in the susceptibility profiles of the isolated yeasts were evidenced during the observation period.

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“…and their antifungal resistance are widely available and suggest influence of local epidemiology on infection and possibly also on its outcome 8, 11–14 . A role for older age, inappropriate or non-timely antifungal therapy and general patient conditions on mortality rate appears to be plausible, though marked differences among the different studies have been reported 5, 8, 13–16 .…”

Section: Introductionmentioning

confidence: 99%

Antibodies against a β-glucan-protein complex of Candida albicans and its potential as indicator of protective immunity in candidemic patients

Torosantucci

Tumbarello

Bromuro

et al. 2017

Sci Rep

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Sera from candidemic and non-candidemic subjects were examined for antibodies against the cell wall β1,3- and β1,6-glucans, as well as the β-glucan-associated protein MP65 of Candida species. Although antibodies against each of the above components were detected in all subjects, candidemic patients had lower antibody titers against β1,3-glucan, but higher antibody titers against β1,6-glucan and MP65, than non-candidemic subjects. The elevated levels of anti-β1,6-glucan and -MP65 antibodies found in candidemic patients were independent on the patient risk category, APACHE II score, presence of co-morbidities, β1,3-glucanemia level, Candida isolate, and antifungal treatment. Interestingly, however, the anti-MP65, but not the anti-β1,6-glucan antibodies, of candidemic patients had higher titers in survivors than in non-survivors, particularly in those subject categories with the highest mortality (>65-years old, diabetic, or septic shock patients). Thus, candidemic patients are capable of boosting anti-Candida immune responses upon infection, and some of these responses might be associated to the generation of protective immunity in patients with candidemia.

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Epidemiology and outcome of candidemia in internal medicine wards: A regional study in Italy

Cited by 40 publications

References 15 publications

A multi-centric Study of Candida bloodstream infection in Lima-Callao, Peru: Species distribution, antifungal resistance and clinical outcomes

A multi-centric Study of Candida bloodstream infection in Lima-Callao, Peru: Species distribution, antifungal resistance and clinical outcomes

Candidaemia in a tertiary care academic hospital in Italy. The impact of C. parapsilosis complex on the species distribution and antifungal susceptibility

Antibodies against a β-glucan-protein complex of Candida albicans and its potential as indicator of protective immunity in candidemic patients

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