Peripheral and total parenteral nutritions as strongest risk factors for nosocomial candidemia among elderly patients: a case-control study

eP803 Abstract (eposter session) Peripheral and total parenteral nutritions as the strongest risk factors for nosocomial candidaemia among elderly patients: a case-control study R. Luzzati*, S. Cavinato, G. Granà, M. Giangreco, M. Deiana, S. Centonze, F. Barbone (Trieste, Verona, Udine, IT) Objectives: Although the highest rates of nosocomial candidemia occur at the extremes of age spectrum, few data on elderly patients exist. We investigate characteristics and risk factors for candidemia in such patient population. Methods: We analyzed all consecutive nosocomial candidemia episodes occurring from January 2008 to June 2011 in an Italian referral hospital. A case-control study to identify risk factors for candidemia including comorbidities, invasive procedures, and medical therapies was performed. For each case, 2 controls were randomly selected among other patients admitted to the same hospital, and individually matched by sex, age, year and month of admission, ward, and duration of hospital admission. The statistical analysis was conducted according to matched case-control methods. The adjusted odds ratio (OR) was calculated using multiple conditional logistic regression. Results: We identified 145 episodes of candidemia occurring in 140 patients (67 females, 48%) with a median age of 80 years (IQR 69.0-85.5 years ). The overall incidence of candidemia was 1.56 episodes per 10,000 patient-days per year. Ninety-three (67%) patients were hospitalized in internal medicine units, 23 (16%) in surgery units, and 24 (17%) in intensive care units. Candida albicans (80 isolates) accounted for 55% of all candidemia episodes. From the multivariate logistic regression models which also included terms for matching variables, candidemia remained statistically significantly associated with duration > 7 days of both total [OR = 23.40; 95% confidence interval (CI): 3.81-143.59]and peripheral parenteral nutrition [OR = 24.82; 95%CI: 6.23-98.82], central vascular catheter [OR = 5.61; 95%CI: 1.32- 23.82], and the following antibiotics for >= 2 days: glicopeptydes [OR = 6.23; 95%CI: 1.88-20.67], aminoglycosides [OR = 2.75; 95%CI: 0.62-12.19], metronidazole [OR = 2.71; 95%CI: 0.80-9.17], and antianaerobic betalactams [OR = 2.44; 95%CI: 1.00-5.94]. The 30-day crude mortality was 45.0% in candidemia cases and 20.7% in controls. Conclusion: Our data show the incidence of candidemia to be high and elderly patients admitted into internal medicine wards to be especially affected by that infection. The longer durations of both total and peripheral parenteral nutritions were found to be the strongest risk factors for candidemia. Prospective studies are warranted to show whether candidemia can be prevented by earlier application of enteral feeding in elderly patients.