What is it about?
Candidemia, a bloodstream infection caused by Candida yeasts, is a serious hospital-acquired infection, and older age is a known risk factor. Yet little was known about its outcome in very old patients. We studied all 683 hospital-acquired candidemia episodes occurring between 2011 and 2013 in six hospitals of north-eastern Italy, comparing patients aged 75 or older (43%) with younger adults. Very old patients were more often in medical wards and had more kidney failure, urinary catheters and intravenous nutrition. They less often received adequate antifungal therapy (73% vs 83%) and less often had their central venous catheter removed (68% vs 80%). Their 30-day mortality was twice as high (48% vs 24%). In younger adults, removing the central catheter was strongly associated with survival.
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Why is it important?
With an ageing population, candidemia in the very old is increasingly common. This study shows that these patients die much more often and receive suboptimal care less frequently in line with guidelines - fewer adequate treatments and fewer catheter removals. Age alone should not lead to less aggressive management, and better adherence to standard care could save lives.
Perspectives
Elderly patients are often treated more cautiously, sometimes too cautiously. This multicentre study from our region shows that very old patients with candidemia deserve the same evidence-based care as younger ones, starting with prompt antifungal therapy and removal of infected catheters whenever possible.
Professor Stefano Di Bella
Universita degli Studi di Trieste
Read the Original
This page is a summary of: Clinical Features and Mortality of Nosocomial Candidemia in Very Old Patients: A Multicentre Italian Study, Gerontology, January 2020, Karger Publishers,
DOI: 10.1159/000510638.
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