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Infect Dis (Lond). 2019 Jun;51(6):425-434. doi: 10.1080/23744235.2019.1595709. Epub 2019 Apr 23.

The impact of age on risk assessment, therapeutic practice and outcome in candidemia.

Author information

1
a Research Institute for Internal Medicine, Oslo University Hospital, Rikshospitalet , Oslo , Norway.
2
b Department of Microbiology , Oslo University Hospital, Rikshospitalet , Oslo , Norway.
3
c Norwegian Mycological Reference Laboratory, Oslo University Hospital , Oslo , Norway.
4
d Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo , Norway.
5
e Oslo Centre for Biostatistics & Epidemiology, Oslo University Hospital , Oslo , Norway.
6
f Department of Microbiology , Haukeland University Hospital , Bergen , Norway.
7
g Department of Infectious Diseases , Haukeland University Hospital , Bergen , Norway.
8
h Department of Infectious Diseases , Akershus University Hospital , Lørenskog , Norway.
9
i Department of Microbiology and Infection Control , Akershus University Hospital , Lørenskog , Norway.
10
j Department of Microbiology , University Hospital of Northern Norway , Tromsø , Norway.
11
k Department of Infectious Diseases , University Hospital of Northern Norway , Tromsø , Norway.
12
l Department of Medical Microbiology , University Hospital of Stavanger , Stavanger , Norway.
13
m Department of Infectious Diseases , University Hospital of Stavanger , Stavanger , Norway.
14
n Department of Microbiology , Trondheim University Hospital , Trondheim , Norway.
15
o Department of Infectious Diseases , Trondheim University Hospital , Trondheim , Norway.
16
p Department of Infectious Diseases , Vestfold Hospital Trust , Tønsberg , Norway.
17
q Section of Clinical immunology and Infectious Diseases , Oslo University Hospital, Rikshospitalet , Oslo , Norway.

Abstract

BACKGROUND:

In Norway, the epidemiological situation of candidemia is followed closely. We have previously demonstrated the highest incidence of candidemia in elderly >65 years of age. However, knowledge of other aspects of this infection is lacking.

OBJECTIVE:

The aim of this nationwide, retrospective study was to examine risk factors, therapeutic practice and outcome in adult candidemia patients according to age.

METHODS:

We retrieved data from medical records from patients who developed candidemia in Norway between 1 January 2008 and 31 December 2012. Data were analyzed according to age, younger patients being between 18 and 65 years, elderly being ≥65 years of age.

RESULTS:

From 771 eligible patients, 738 patients (95.7%) were included (58% men, mean age 65.2 years, 58.1% being ≥65 years). Exposure to health-care related risk factors for candidemia were significantly more common in the younger patients (neutropenia, central venous catheter, mechanical ventilation and chemotherapy) who received empirical treatment more often than the elderly (29.8% vs. 21.7%, p = .01). More elderly did not received any antifungal therapy (27.3% vs 16.8%, p < 0001) and had higher mortality compared to younger patients (45.5% vs 23.9%, p < .0001). In the study population, mortality was higher with age (per 10-years increase, OR 1.43;1.28-1.59, p < 0.0001), in patients not receiving targeted therapy (OR 2.5; CI 1.82-3.36, p < .0001) or any therapy at all (OR 4.64; 3.23-6.68, p < .0001).

CONCLUSIONS:

Risk factors for candidemia, treatment and outcome differed significantly according to age. Given the increasing numbers of elderly, scrutiny on our clinical practice is warranted.

KEYWORDS:

30-day mortality; Candidemia; elderly; risk factors; targeted treatment

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