Introduction: Being elderly is a well-known risk factor for candidemia, but few data are available on the prognostic impact of candidemia in the very old (VO) subjects, as defined as people aged ≥75 years. Objective: The aim of this study was to assess risk factors for nosocomial candidemia in two groups of candidemia patients, consisting of VO patients (≥75 years) and adult and old (AO) patients (18–74 years). In addition, risk factors for death (30-day mortality) were analysed separately in the two groups. Methods: We included all consecutive candidemia episodes from January 2011 to December 2013 occurring in six referral hospitals in north-eastern Italy. Results: A total of 683 nosocomial candidemia episodes occurred. Of those, 293 (42.9%) episodes were in VO and 390 (57.1%) in AO patients. Hospitalization in medical wards, chronic renal failure, urinary catheter, and peripheral parenteral nutrition (PPN) were more common in VO than in AO patients. In the former patient group, adequate antifungal therapy (73.2%) and central venous catheter (CVC) removal (67.6%) occurred less frequently than in AO patients (82.5 and 80%, p < 0.002 and p < 0.004, respectively). Thirty-day mortality was higher in VO compared to AO patients (47.8 vs. 23.6%, p < 0.0001). In AO patients, independent risk factors for death were age (OR 1.04, 95% CI 1.00–1.09, p = 0.038), recent history of chemotherapy (OR 22.01, 95% CI 3.12–155.20, p = 0.002), and severity of sepsis (OR 40.68, 95% CI 7.42–223.10, p < 0.001); CVC removal was associated with higher probability of survival (OR 0.10, 95% CI 0.03–0.33, p < 0.001). In VO patients, independent risk factors for death were PPN (OR 3.5, 95% CI 1.17–10.47, p = 0.025) and hospitalization in medical wards (OR 2.58, 95% CI 1.02–6.53, p = 0.046), while CVC removal was associated with improved survival (OR 0.40, 95% CI 0.16–1.00, p = 0.050). Conclusion: Thirty-day mortality was high among VO patients and was associated with inadequate management of candidemia, especially in medical wards.

1.
Magill
SS
,
O’Leary
E
,
Janelle
SJ
,
Thompson
DL
,
Dumyati
G
,
Nadle
J
, et al;
Emerging Infections Program Hospital Prevalence Survey Team
.
Changes in prevalence of health care-associated infections in U.S. Hospitals
.
N Engl J Med
.
2018
Nov
;
379
(
18
):
1732
44
.
[PubMed]
0028-4793
2.
Koehler
P
,
Stecher
M
,
Cornely
OA
,
Koehler
D
,
Vehreschild
MJ
,
Bohlius
J
, et al
Morbidity and mortality of candidaemia in Europe: an epidemiologic meta-analysis
.
Clin Microbiol Infect
.
2019
Oct
;
25
(
10
):
1200
12
.
[PubMed]
1198-743X
3.
Magill
SS
,
Edwards
JR
,
Bamberg
W
,
Beldavs
ZG
,
Dumyati
G
,
Kainer
MA
, et al;
Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team
.
Multistate point-prevalence survey of health care-associated infections
.
N Engl J Med
.
2014
Mar
;
370
(
13
):
1198
208
.
[PubMed]
0028-4793
4.
Bassetti
M
,
Giacobbe
DR
,
Vena
A
,
Trucchi
C
,
Ansaldi
F
,
Antonelli
M
, et al
Incidence and outcome of invasive candidiasis in intensive care units (ICUs) in Europe: results of the EUCANDICU project
.
Crit Care
.
2019
Jun
;
23
(
1
):
219
.
[PubMed]
1364-8535
5.
Tissot
F
,
Agrawal
S
,
Pagano
L
,
Petrikkos
G
,
Groll
AH
,
Skiada
A
, et al
ECIL-6 guidelines for the treatment of invasive candidiasis, aspergillosis and mucormycosis in leukemia and hematopoietic stem cell transplant patients
.
Haematologica
.
2017
Mar
;
102
(
3
):
433
44
.
[PubMed]
0390-6078
6.
Criscuolo
M
,
Marchesi
F
,
Candoni
A
,
Cattaneo
C
,
Nosari
A
,
Veggia
B
, et al;
SEIFEM Group (Sorveglianza Epidemiologica Infezioni nelle Emopatie)
.
Fungaemia in haematological malignancies: SEIFEM-2015 survey
.
Eur J Clin Invest
.
2019
May
;
49
(
5
):
e13083
.
[PubMed]
0014-2972
7.
Bassetti
M
,
Molinari
MP
,
Mussap
M
,
Viscoli
C
,
Righi
E
.
Candidaemia in internal medicine departments: the burden of a rising problem
.
Clin Microbiol Infect
.
2013
Jun
;
19
(
6
):
E281
4
.
[PubMed]
1198-743X
8.
Luzzati
R
,
Merelli
M
,
Ansaldi
F
,
Rosin
C
,
Azzini
A
,
Cavinato
S
, et al
Nosocomial candidemia in patients admitted to medicine wards compared to other wards: a multicentre study
.
Infection
.
2016
Dec
;
44
(
6
):
747
55
.
[PubMed]
0300-8126
9.
Almirante
B
,
Rodríguez
D
,
Park
BJ
,
Cuenca-Estrella
M
,
Planes
AM
,
Almela
M
, et al;
Barcelona Candidemia Project Study Group
.
Epidemiology and predictors of mortality in cases of Candida bloodstream infection: results from population-based surveillance, barcelona, Spain, from 2002 to 2003
.
J Clin Microbiol
.
2005
Apr
;
43
(
4
):
1829
35
.
[PubMed]
0095-1137
10.
Ramos-Martínez
A
,
Vicente-López
N
,
Sánchez-Romero
I
,
Padilla
B
,
Merino-Amador
P
,
Garnacho-Montero
J
, et al;
Members of the CANDIPOP Project from GEIH-GEMICOMED (SEIMC) and REIPI
.
Epidemiology and prognosis of candidaemia in elderly patients
.
Mycoses
.
2017
Dec
;
60
(
12
):
808
17
.
[PubMed]
0933-7407
11.
Wang
H
,
Liu
N
,
Yin
M
,
Han
H
,
Yue
J
,
Zhang
F
, et al
The epidemiology, antifungal use and risk factors of death in elderly patients with candidemia: a multicentre retrospective study
.
BMC Infect Dis
.
2014
Nov
;
14
(
1
):
609
.
[PubMed]
1471-2334
12.
Flevari
A
,
Theodorakopoulou
M
,
Velegraki
A
,
Armaganidis
A
,
Dimopoulos
G
.
Treatment of invasive candidiasis in the elderly: a review
.
Clin Interv Aging
.
2013
;
8
:
1199
208
.
[PubMed]
1178-1998
13.
Luzzati
R
,
Cavinato
S
,
Deiana
ML
,
Rosin
C
,
Maurel
C
,
Borelli
M
.
Epidemiology and outcome of nosocomial candidemia in elderly patients admitted prevalently in medical wards
.
Aging Clin Exp Res
.
2015
Apr
;
27
(
2
):
131
7
.
[PubMed]
1594-0667
14.
Ouchi
Y
,
Rakugi
H
,
Arai
H
,
Akishita
M
,
Ito
H
,
Toba
K
, et al;
Joint Committee of Japan Gerontological Society (JGLS) and Japan Geriatrics Society (JGS) on the definition and classification of the elderly
.
Redefining the elderly as aged 75 years and older: Proposal from the Joint Committee of Japan Gerontological Society and the Japan Geriatrics Society
.
Geriatr Gerontol Int
.
2017
Jul
;
17
(
7
):
1045
7
.
[PubMed]
1444-1586
15.
Tang
HJ
,
Liu
WL
,
Lin
HL
,
Lai
CC
.
Epidemiology and prognostic factors of candidemia in elderly patients
.
Geriatr Gerontol Int
.
2015
Jun
;
15
(
6
):
688
93
.
[PubMed]
1444-1586
16.
Thorell
K
,
Midlöv
P
,
Fastbom
J
,
Halling
A
.
Importance of potentially inappropriate medications, number of chronic conditions and medications for the risk of hospitalisation in elderly in Sweden: a case-control study
.
BMJ Open
.
2019
Sep
;
9
(
9
):
e029477
.
[PubMed]
2044-6055
17.
Bone
RC
,
Balk
RA
,
Cerra
FB
,
Dellinger
RP
,
Fein
AM
,
Knaus
WA
, et al;
The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine
.
Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis
.
Chest
.
1992
Jun
;
101
(
6
):
1644
55
.
[PubMed]
0012-3692
18.
Charlson
ME
,
Pompei
P
,
Ales
KL
,
MacKenzie
CR
.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
.
J Chronic Dis
.
1987
;
40
(
5
):
373
83
.
[PubMed]
0021-9681
19.
EUCAST
.
Clinical breakpoints and dosing of antibiotics n.d.
http://www.eucast.org/clinical_breakpoints/ (accessed March 2, 2019).
20.
Harper
S.
Economic and social implications of aging societies.
Science (80-)
2014
;346:587–91.
21.
Reunes
S
,
Rombaut
V
,
Vogelaers
D
,
Brusselaers
N
,
Lizy
C
,
Cankurtaran
M
, et al
Risk factors and mortality for nosocomial bloodstream infections in elderly patients
.
Eur J Intern Med
.
2011
Oct
;
22
(
5
):
e39
44
.
[PubMed]
0953-6205
22.
Guimarães
T
,
Nucci
M
,
Mendonça
JS
,
Martinez
R
,
Brito
LR
,
Silva
N
, et al
Epidemiology and predictors of a poor outcome in elderly patients with candidemia
.
Int J Infect Dis
.
2012
Jun
;
16
(
6
):
e442
7
.
[PubMed]
1201-9712
23.
Barchiesi
F
,
Orsetti
E
,
Mazzanti
S
,
Trave
F
,
Salvi
A
,
Nitti
C
, et al
Candidemia in the elderly: what does it change?
PLoS One
.
2017
May
;
12
(
5
):
e0176576
.
[PubMed]
1932-6203
24.
Hesstvedt
L
,
Gaustad
P
,
Müller
F
,
Torp Andersen
C
,
Brunborg
C
,
Mylvaganam
H
, et al;
Norwegian Fungal Network
.
The impact of age on risk assessment, therapeutic practice and outcome in candidemia
.
Infect Dis (Lond)
.
2019
Jun
;
51
(
6
):
425
34
.
[PubMed]
2374-4235
25.
Morrell
M
,
Fraser
VJ
,
Kollef
MH
.
Delaying the empiric treatment of candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality
.
Antimicrob Agents Chemother
.
2005
Sep
;
49
(
9
):
3640
5
.
[PubMed]
0066-4804
26.
Parkins
MD
,
Sabuda
DM
,
Elsayed
S
,
Laupland
KB
.
Adequacy of empirical antifungal therapy and effect on outcome among patients with invasive Candida species infections
.
J Antimicrob Chemother
.
2007
Sep
;
60
(
3
):
613
8
.
[PubMed]
0305-7453
27.
Garey
KW
,
Rege
M
,
Pai
MP
,
Mingo
DE
,
Suda
KJ
,
Turpin
RS
, et al
Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study
.
Clin Infect Dis
.
2006
Jul
;
43
(
1
):
25
31
.
[PubMed]
1058-4838
28.
Pappas
PG
,
Kauffman
CA
,
Andes
DR
,
Clancy
CJ
,
Marr
KA
,
Ostrosky-Zeichner
L
, et al
Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America
.
Clin Infect Dis
.
2016
Feb
;
62
(
4
):
e1
50
.
[PubMed]
1058-4838
29.
Cornely
OA
,
Bassetti
M
,
Calandra
T
,
Garbino
J
,
Kullberg
BJ
,
Lortholary
O
, et al;
ESCMID Fungal Infection Study Group
.
ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients
.
Clin Microbiol Infect
.
2012
Dec
;
18
Suppl 7
:
19
37
.
[PubMed]
1198-743X
30.
Yang
Y
,
Yang
KS
,
Hsann
YM
,
Lim
V
,
Ong
BC
.
The effect of comorbidity and age on hospital mortality and length of stay in patients with sepsis
.
J Crit Care
.
2010
Sep
;
25
(
3
):
398
405
.
[PubMed]
0883-9441
31.
Nasa
P
,
Juneja
D
,
Singh
O
.
Severe sepsis and septic shock in the elderly: an overview
.
World J Crit Care Med
.
2012
Feb
;
1
(
1
):
23
30
.
[PubMed]
2220-3141
32.
Vena
A
,
Bouza
E
,
Valerio
M
,
Padilla
B
,
Paño-Pardo
JR
,
Fernández-Ruiz
M
, et al;
CANDIPOP Project
.
Candidemia in non-ICU surgical wards: comparison with medical wards
.
PLoS One
.
2017
Oct
;
12
(
10
):
e0185339
.
[PubMed]
1932-6203
33.
Bassetti
M
,
Righi
E
,
Ansaldi
F
,
Merelli
M
,
Trucchi
C
,
De Pascale
G
, et al
A multicenter study of septic shock due to candidemia: outcomes and predictors of mortality
.
Intensive Care Med
.
2014
Jun
;
40
(
6
):
839
45
.
[PubMed]
0342-4642
34.
Luzzati
R
,
Cavinato
S
,
Giangreco
M
,
Granà
G
,
Centonze
S
,
Deiana
ML
, et al
Peripheral and total parenteral nutrition as the strongest risk factors for nosocomial candidemia in elderly patients: a matched case-control study
.
Mycoses
.
2013
Nov
;
56
(
6
):
664
71
.
[PubMed]
0933-7407
35.
Bassetti
M
,
Merelli
M
,
Righi
E
,
Diaz-Martin
A
,
Rosello
EM
,
Luzzati
R
, et al
Epidemiology, species distribution, antifungal susceptibility, and outcome of candidemia across five sites in Italy and Spain
.
J Clin Microbiol
.
2013
Dec
;
51
(
12
):
4167
72
.
[PubMed]
0095-1137
36.
Tascini
C
,
Falcone
M
,
Bassetti
M
,
De Rosa
FG
,
Sozio
E
,
Russo
A
, et al
Candidemia in Patients with Body Temperature Below 37°C and Admitted to Internal Medicine Wards: Assessment of Risk Factors
.
Am J Med
.
2016
Dec
;
129
(
12
):
1330.e1
6
.
[PubMed]
0002-9343
37.
Menichetti
F
,
Bertolino
G
,
Sozio
E
,
Carmignani
C
,
Rosselli Del Turco
E
,
Tagliaferri
E
, et al;
GISA (Italian Group for Antimicrobial Stewardship) Candidemia Study Group
.
Impact of infectious diseases consultation as a part of an antifungal stewardship programme on candidemia outcome in an Italian tertiary-care, University hospital
.
J Chemother
.
2018
Sep
;
30
(
5
):
304
9
.
[PubMed]
1120-009X
38.
Nucci
M
,
Anaissie
E
,
Betts
RF
,
Dupont
BF
,
Wu
C
,
Buell
DN
, et al
Early removal of central venous catheter in patients with candidemia does not improve outcome: analysis of 842 patients from 2 randomized clinical trials
.
Clin Infect Dis
.
2010
Aug
;
51
(
3
):
295
303
.
[PubMed]
1058-4838
39.
Garnacho-Montero
J
,
Díaz-Martín
A
,
García-Cabrera
E
,
Ruiz Pérez de Pipaón
M
,
Hernández-Caballero
C
,
Lepe-Jiménez
JA
.
Impact on hospital mortality of catheter removal and adequate antifungal therapy in Candida spp. bloodstream infections
.
J Antimicrob Chemother
.
2013
Jan
;
68
(
1
):
206
13
.
[PubMed]
0305-7453
40.
Orsetti
E
,
Brescini
L
,
Mazzanti
S
,
Trave
F
,
Morroni
G
,
Pocognoli
A
, et al
Central venous catheter unrelated candidemia influences the outcome of infection in patients with solid tumors
.
Eur J Clin Microbiol Infect Dis
.
2019
Aug
;
38
(
8
):
1499
505
.
[PubMed]
0934-9723
41.
Lortholary
O
,
Renaudat
C
,
Sitbon
K
,
Desnos-Ollivier
M
,
Bretagne
S
,
Dromer
F
;
French Mycoses Study Group
.
The risk and clinical outcome of candidemia depending on underlying malignancy
.
Intensive Care Med
.
2017
May
;
43
(
5
):
652
62
.
[PubMed]
0342-4642
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.