Nosocomial candidemia in an Italian tertiary care hospital

In a retrospective ongoing study, the incidence of nosocomial candidemia among patients (pts) admitted to a tertiary-care teaching hospital (bed capacity 2400; 78 beds for intensive care units, ICUs) was evaluated together with causative pathogens, potential risk factors, antifungal treatment, and crude mortality. During the primary study period (November 1991—October 1994) there were 136 episodes of candidemia occurring in 136 pts (median age 62 years, range 4–96). The overall incidence of candidemia was 11.3 episodes per 10 000 hospital admissions. The underlying diseases were the following: solid or hematological malignancies (43 pts), major abdominal surgery (30 pts), cardiovascular diseases (18 pts), trauma (17 pts), other diseases (28 pts). At the onset of candidemia 67 pts (49%) were located in ICUs, 48 and 21 pts respectively in surgical and medical wards. C. albicans (83 strains) accounted for 53% of all blood culture Candida isolates. Fifty-three pts (39%) received adequate antifungal treatment: 16 pts amphotericin-B and 37 pts fluconazole. The overall crude mortality was 54%. The number of positive fungal blood cultures (1 culture versus >1 culture) did not influence crude mortality (54% versus 63%). In addition, the mortality of pts infected by C. albicans (55%) was similar to that of pts infected by C. non-albicans species (45%). The mortality of pts located in ICUs (79%) was significantly higher (P < 0.001) than that of pts in surgical (29%) and medical wards (33%). Finally, the mortality of pts who did not receive adequate antifungal therapy (70%) was significantly higher (P < 0.001) than that of treated pts (30%). In conclusion, the incidence of nosocomial candidemia was high during the primary phase of the study; most of our pts with candidemia had severe underlying diseases and were hospitalized in ICUs. The number of fungal positive blood cultures did not influence the crude mortality, confirming that a single bood culture shuld not be dismissed as benign transient candidemia. On the contrary, about two-third of our pts did not receive an adequate antifungal treatment and the majority of them died.