, Volume 46, Issue 5, pp 625–633 | Cite as

A prediction rule for early recognition of patients with candidemia in Internal Medicine: results from an Italian, multicentric, case–control study

  • Emanuela SozioEmail author
  • Filippo Pieralli
  • Anna Maria Azzini
  • Giancarlo Tintori
  • Federica Demma
  • Gianluca Furneri
  • Francesco Sbrana
  • Giacomo Bertolino
  • Simona Fortunato
  • Simone Meini
  • Damiano Bragantini
  • Alessandro Morettini
  • Carlo Nozzoli
  • Francesco Menichetti
  • Ercole Concia
  • Carlo Tascini
  • on behalf of GISA/FADOI Candida Study Group
Original Paper



Increasing prevalence of candidemia in Internal Medicine wards (IMWs) has been reported in recent years, but risk factors for candida bloodstream infection in patients admitted to IMW may differ from those known in other settings. The aim of this study was to identify risk factors and define a prediction rule for the early recognition of the risk of candidemia in IMW inpatients.


This was a multicentric, retrospective, observational case–control study on non-neutropenic patients with candidemia admitted to IMWs of four large Italian Hospitals. Each eligible patient with candidemia (case) was matched to a control with bacteremia. Stepwise logistic regression analyses were performed.


Overall, 300 patients (150 cases and 150 controls) were enrolled. The following factors were associated with an increased risk of candidemia and weighted to build a score: total parenteral nutrition (OR 2.45, p = 0.008; 1 point); central venous catheter (OR 2.19, p = 0.031; 1 point); peripherally inserted central catheter (OR 5.63, p < 0.0001; 3 points), antibiotic treatment prior (OR 2.06; p = 0.059; 1 point) and during hospitalization (OR2.38, p = 0.033; 1 point); neurological disability (OR 2.25, p = 0.01; 1 point); and previous hospitalization within 3 months (OR 1.56, p = 0.163; 1 point). At ROC curve analysis, a final score ≥ 4 showed 84% sensitivity, 76% specificity, and 80% accuracy in predicting the risk of candidemia.


The proposed scoring system showed to be a simple and highly performing tool in distinguishing bloodstream infections due to Candida and bacteria in patients admitted to IMW. The proposed rule might help to reduce delay in empirical treatment and improve appropriateness in antifungal prescription in septic patients.


Candidemia Internal medicine wards Prediction rule Risk factors 



No financial support was received.

Compliance with ethical standards

Conflict of interest

CT has received funds for speaking at symposia organized on behalf of Pfizer, Novartis, Merck, and Astellas. All other authors: none to declare.

Supplementary material

15010_2018_1162_MOESM1_ESM.docx (22 kb)
Supplementary material 1 (DOCX 21 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Emanuela Sozio
    • 1
    Email author
  • Filippo Pieralli
    • 2
  • Anna Maria Azzini
    • 3
  • Giancarlo Tintori
    • 4
  • Federica Demma
    • 5
  • Gianluca Furneri
    • 5
  • Francesco Sbrana
    • 6
  • Giacomo Bertolino
    • 7
  • Simona Fortunato
    • 8
  • Simone Meini
    • 9
  • Damiano Bragantini
    • 3
  • Alessandro Morettini
    • 10
  • Carlo Nozzoli
    • 10
  • Francesco Menichetti
    • 8
  • Ercole Concia
    • 3
  • Carlo Tascini
    • 11
  • on behalf of GISA/FADOI Candida Study Group
  1. 1.Emergency DepartmentNorth-West District, Tuscany HealthCare, Spedali Riuniti LivornoLeghornItaly
  2. 2.Intermediate Care UnitAzienda Ospedaliera Universitaria CareggiFlorenceItaly
  3. 3.Infectious Disease UnitAzienda Ospedaliera Universitaria Integrata di VeronaVeronaItaly
  4. 4.Emergency Medicine Unit, Nuovo Santa Chiara University HospitalAzienda Ospedaliera Universitaria PisanaPisaItaly
  5. 5.Health Economics and Outcome Research Department-EBMA ConsultingMilanItaly
  6. 6.Fondazione Toscana Gabriele MonasterioPisaItaly
  7. 7.Pharmaceutical DepartmentOspedale di SassuoloModenaItaly
  8. 8.Infectious Diseases Clinic, Nuovo Santa Chiara University HospitalAzienda Ospedaliera Universitaria PisanaPisaItaly
  9. 9.Department of Internal MedicineS.M. Annunziata HospitalFlorenceItaly
  10. 10.Internal Medicine UnitAzienda Ospedaliera Universitaria CareggiFlorenceItaly
  11. 11.First Division of Infectious Diseases, Cotugno HospitalAzienda Ospedaliera dei ColliNaplesItaly

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