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

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Funding

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Authors and Affiliations

  1. Emergency Department, North-West District, Tuscany HealthCare, Spedali Riuniti Livorno, Viale Alfieri 36, 57100, Leghorn, Italy

    Emanuela Sozio

  2. Intermediate Care Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy

    Filippo Pieralli

  3. Infectious Disease Unit, Azienda Ospedaliera Universitaria Integrata di Verona, p.Le LA Scuro, Verona, Italy

    Anna Maria Azzini, Damiano Bragantini & Ercole Concia

  4. Emergency Medicine Unit, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy

    Giancarlo Tintori

  5. Health Economics and Outcome Research Department-EBMA Consulting, Milan, Italy

    Federica Demma & Gianluca Furneri

  6. Fondazione Toscana Gabriele Monasterio, Pisa, Italy

    Francesco Sbrana

  7. Pharmaceutical Department, Ospedale di Sassuolo, Modena, Italy

    Giacomo Bertolino

  8. Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy

    Simona Fortunato & Francesco Menichetti

  9. Department of Internal Medicine, S.M. Annunziata Hospital, Florence, Italy

    Simone Meini

  10. Internal Medicine Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy

    Alessandro Morettini & Carlo Nozzoli

  11. First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy

    Carlo Tascini

Authors
  1. Emanuela Sozio
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  2. Filippo Pieralli
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on behalf of GISA/FADOI Candida Study Group

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Correspondence to Emanuela Sozio.

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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.

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Sozio, E., Pieralli, F., Azzini, A.M. et al. A prediction rule for early recognition of patients with candidemia in Internal Medicine: results from an Italian, multicentric, case–control study. Infection 46, 625–633 (2018). https://doi.org/10.1007/s15010-018-1162-0

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  • DOI: https://doi.org/10.1007/s15010-018-1162-0

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