Candidemia in non-ICU surgical wards: Comparison with medical wards

PLoS One. 2017 Oct 18;12(10):e0185339. doi: 10.1371/journal.pone.0185339. eCollection 2017.

Abstract

Candidemia acquired outside critical care or hematological areas has received much attention in recent years; however, data on candidemia in surgical departments are very scarce. Our objectives were to describe episodes of candidemia diagnosed in surgical wards and to compare them with episodes occurring in medical wards. We performed a post hoc analysis of a prospective, multicenter study implemented in Spain during 2010-2011 (CANDIPOP project). Of the 752 episodes of candidemia, 369 (49.1%) occurred in patients admitted to surgical wards (165, 21.9%) or medical wards (204, 27.2%). Clinical characteristics associated with surgical patients were solid tumor as underlying disease, recent surgery, indwelling CVC, and parenteral nutrition. Candidemia was more commonly related to a CVC in the surgical than in the medical wards. The CVC was removed more frequently and early management was more appropriate within 48 hours of blood sampling in the surgical patients. Overall, 30-day mortality in the surgical departments was significantly lower than in medical wards (37.7% vs. 15.8%, p<0.001). Multivariate analysis revealed admission to a surgical ward and appropriate early management of candidemia as factors independently associated with a better outcome. We found that approximately 50% of episodes of candidemia occurred in non-hematological patients outside the ICU and that clinical outcome was better in patients admitted to surgical wards than in those hospitalized in medical wards. These findings can be explained by the lower severity of underlying disease, prompt administration of antifungal therapy, and central venous catheter removal.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Candidemia / epidemiology*
  • Demography
  • Female
  • Hospitalization
  • Humans
  • Intensive Care Units*
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Patients' Rooms / statistics & numerical data*
  • Risk Factors
  • Surgical Procedures, Operative / mortality
  • Treatment Outcome

Grants and funding

The CANDIPOP study was cofounded by Fundación SEIMC-GESIDA (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica-Grupo de Estudio de SIDA), by the Spanish Ministry of Economy and Competitiveness, Instituto de Salud Carlos III (cofinanced by the European Development Regional Fund “A way to achieve Europe”), and by the Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015). The present study was financed by the PROgrama MULtidisciplinar para la Gestión de Antifúngicos y la Reducción de Candidiasis Invasora (PROMULGA) II Project, Instituto de Salud Carlos III Madrid Spain, and by the European Regional Development Fund (FEDER) “A way of making Europe” (grant number PI13/01148). Antonio Vena is supported by a Rio Hortega from the Instituto de Salud Carlos III Madrid Spain, partially financed by the European Regional Development Fund (FEDER) “A way of making Europe” (grant number CM15/00181). Mario Fernandez Ruiz. holds a clinical research contract “Juan Rodés” (JR14/00036) from the Spanish Ministry of Economy and Competitiveness, Instituto de Salud Carlos III.