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

Sozio, Emanuela; Pieralli, Filippo; Azzini, Anna Maria; Tintori, Giancarlo; Demma, Federica; Furneri, Gianluca; Sbrana, Francesco; Bertolino, Giacomo; Fortunato, Simona; Meini, Simone; Bragantini, Damiano; Morettini, A; Nozzoli, Carlo; Menichetti, Francesco; Concia, Ercole; Tascini, Carlo

doi:10.1007/s15010-018-1162-0

Cited by 9 publications

(7 citation statements)

References 45 publications

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“…Candidemia is a deadly infection found all over the world, accounting for 9% of all nosocomial bloodstream infection (BSI) [1,2]. This infection is associated with considerable morbidity and mortality, including prolonged hospital stays and increased healthcare costs, with 30% to 50% occurring in patients in the intensive care unit (ICU) [3].…”

Section: Introductionmentioning

confidence: 99%

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The Overlooked Immune State in Candidemia: A Risk Factor for Mortality

Ortega-Loubón

Cano-Hernández²,

Poves-Álvarez³

et al. 2019

JCM

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Lymphopenia has been related to increased mortality in septic patients. Nonetheless, the impact of lymphocyte count on candidemia mortality and prognosis has not been addressed. We conducted a retrospective study, including all admitted patients with candidemia from 2007 to 2016. We examined lymphocyte counts during the first 5 days following the diagnosis of candidemia. Multivariable logistic regression analysis was performed to determine the relationship between lymphocyte count and mortality. Classification and Regression Tree analysis was used to identify the best cut-off of lymphocyte count for mortality associated with candidemia. From 296 cases of candidemia, 115 died, (39.8% 30-day mortality). Low lymphocyte count was related to mortality and poor outcome (p < 0.001). Lymphocyte counts < 0.703 × 109 cells/L at diagnosis (area under the curve (AUC)-ROC, 0.783 ± 0.042; 95% confidence interval (CI), 0.700–0.867, p < 0.001), and lymphocyte count < 1.272 × 109 cells/L five days later (AUC-ROC, 0.791 ± 0.038; 95%CI, 0.716–0.866, p < 0.001) increased the odds of mortality five-fold (odds ratio (OR), 5.01; 95%CI, 2.39–10.93) at time of diagnosis, and three-fold (OR, 3.27; 95%CI, 1.24–8.62) by day 5, respectively. Low lymphocyte count is an independent predictor of mortality in patients with candidemia and might serve as a biomarker for predicting candidemia-associated mortality and poor outcome.

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Section: Introductionmentioning

confidence: 99%

“…The etiology in non-neutropenic patients is likely to be multifactorial. Contributing factors might be patients with severe comorbidities, invasive devices, complex procedures, total parenteral nutrition (TPN), broad-spectrum antibacterial agents, and aggressive immunosuppressive therapies [1,7,18,19].…”

Section: Introductionmentioning

confidence: 99%

The Overlooked Immune State in Candidemia: A Risk Factor for Mortality

Ortega-Loubón

Cano-Hernández²,

Poves-Álvarez³

et al. 2019

JCM

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“…Several predictive scores of invasive fungal infections are available [ 17 , 18 , 19 ] and include variables that are largely present in most hospitalized patients or are very impractical to obtain in non-intensive care units, such as the number of Candida colonization sites. The predictive power of these variables is therefore poor.…”

Section: Discussionmentioning

confidence: 99%

Post-Prescription Audit Plus Beta-D-Glucan Assessment Decrease Echinocandin Use in People with Suspected Invasive Candidiasis

et al. 2021

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Background and Objectives: Overtreatment with antifungal drugs is often observed. Antifungal stewardship (AFS) focuses on optimizing the treatment for invasive fungal diseases. The objective of the present study was to evaluate the utility of a post-prescription audit plus beta-D-glucan (BDG) assessment on reducing echinocandin use in persons with suspected invasive candidiasis. Materials and Methods: This is a prospective, pre-post quasi-experimental study of people starting echinocandins for suspected invasive candidiasis. The intervention of the study included review of each echinocandin prescription and discontinuation of treatment if a very low probability of fungal disease or a negative BDG value were found. Pre-intervention data were compared with the intervention phase. The primary outcome of the study was the duration of echinocandin therapy. Secondary outcomes were length of hospital stay and mortality. Results: Ninety-two echinocandin prescriptions were reviewed, 49 (53.3%) in the pre-intervention phase and 43 (46.7%) in the intervention phase. Discontinuation of antifungal therapy was possible in 21 of the 43 patients in the intervention phase (48.8%). The duration of echinocandin therapy was 7.4 (SD 4.7) in the pre-intervention phase, 4.1 days (SD 2.9) in persons undergoing the intervention, and 8.6 (SD 7.3) in persons in whom the intervention was not feasible (p at ANOVA = 0.016). Length of stay and mortality did not differ between pre-intervention and intervention phases. Conclusions: An intervention based on pre-prescription restriction and post-prescription audit when combined with BDG measurement is effective in optimizing antifungal therapy by significantly reducing excessive treatment duration.

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“…However, the figures reported above indicate that these criteria have an inadequate predictive capacity. Recently developed risk assessment models specific to IMU inpatients [4,8] have not been prospectively validated. These are certainly useful scientific contributions to the research needed on such a challenging issue, but the identification of a highly effective predictive tool still seems a difficult goal to achieve.…”

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confidence: 99%

“…Candida and Ostrosky-Zeichner score). An attempt to describe factors associated with an increased risk of candidemia in Internal Medicine patients has been recently published [8]. In that study, 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).…”

mentioning

confidence: 99%