Nosocomial candidemia in non-neutropenic patients at an Italian tertiary care hospital

In a retrospective study conducted in an Italian tertiary care hospital, th e incidence of nosocomial candidemia was evaluated together with causative pathogens, treatment, and risk factors for death. Over a 6-year period (199 2-1997), a total of 189 episodes of candidemia occurred in 189 patients (me an age 58+/-19 years), accounting for an average incidence of 1.14 episodes per 10,000 patient-days per year. The most common reasons for hospitalizat ion were solid neoplasia (21%), trauma (17%), abdominal diseases requiring surgery (13%), and cardiovascular diseases (13%). No patient was neutropeni c within 3 weeks prior to the onset of candidemia. One hundred thirty patie nts were hospitalized in intensive care units, 47 patients in surgical ward s, and 12 patients in medical wards. Candida albicans was the most frequent ly isolated pathogen, accounting for 54% of fungal isolates, followed by Ca ndida parapsilosis (23%), Candida glabrata (7%), Candida tropicalis (5%), C andida pelliculosa (4%), Candida lusitaniae (1%), Candida humicula (1%), an d other non-albicans Candida spp. (5%). Seventy-six (41%) patients received adequate antifungal therapy. Seventy-one (58%) of the 123 evaluable patien ts with central venous catheters underwent line removal; 51 of them had cat heter-related candidemia. The 30-day crude mortality rate was 45%. Older ag e, hospitalization in an intensive care unit, a longer duration of candidem ia, retention of central lines, and inadequate antifungal therapy were sign ificantly associated with poor outcome. In the present study, nosocomial ca ndidemia was a frequent and relatively underestimated illness. Adequate ant ifungal therapy and central line removal independently reduced the high mor tality of the disease.