Supplementary Material for: Clinical Features and Mortality of Nosocomial Candidemia in Very Old Patients: A Multicentre Italian Study

Introduction: Being elderly is a well-known risk factor for candidemia, but few data are available on the prognostic impact of candidemia in the very old (VO) subjects, as defined as people aged ≥75 years. Objective: The aim of this study was to assess risk factors for nosocomial candidemia in two groups of candidemia patients, consisting of VO patients (≥75 years) and adult and old (AO) patients (18–74 years). In addition, risk factors for death (30-day mortality) were analysed separately in the two groups. Methods: We included all consecutive candidemia episodes from January 2011 to December 2013 occurring in six referral hospitals in north-eastern Italy. Results: A total of 683 nosocomial candidemia episodes occurred. Of those, 293 (42.9%) episodes were in VO and 390 (57.1%) in AO patients. Hospitalization in medical wards, chronic renal failure, urinary catheter, and peripheral parenteral nutrition (PPN) were more common in VO than in AO patients. In the former patient group, adequate antifungal therapy (73.2%) and central venous catheter (CVC) removal (67.6%) occurred less frequently than in AO patients (82.5 and 80%, p < 0.002 and p < 0.004, respectively). Thirty-day mortality was higher in VO compared to AO patients (47.8 vs. 23.6%, p < 0.0001). In AO patients, independent risk factors for death were age (OR 1.04, 95% CI 1.00–1.09, p = 0.038), recent history of chemotherapy (OR 22.01, 95% CI 3.12–155.20, p = 0.002), and severity of sepsis (OR 40.68, 95% CI 7.42–223.10, p < 0.001); CVC removal was associated with higher probability of survival (OR 0.10, 95% CI 0.03–0.33, p < 0.001). In VO patients, independent risk factors for death were PPN (OR 3.5, 95% CI 1.17–10.47, p = 0.025) and hospitalization in medical wards (OR 2.58, 95% CI 1.02–6.53, p = 0.046), while CVC removal was associated with improved survival (OR 0.40, 95% CI 0.16–1.00, p = 0.050). Conclusion: Thirty-day mortality was high among VO patients and was associated with inadequate management of candidemia, especially in medical wards.

引言：老年是念珠菌血症的公认危险因素，但针对定义为年龄≥75岁的极老年（Very Old, VO）人群罹患念珠菌血症的预后影响，现有相关数据仍较为匮乏。
研究目的：本研究旨在评估两类念珠菌血症患者的医院获得性念珠菌血症危险因素，分别为极老年（VO）患者（≥75岁）与成年及老年（Adult and Old, AO）患者（18~74岁）。此外，本研究还针对两组患者分别分析了死亡（30天死亡率）的危险因素。
研究方法：本研究纳入了2011年1月至2013年12月期间，意大利东北部6家转诊医院内发生的所有连续性念珠菌血症病例。
研究结果：本研究共纳入683例医院获得性念珠菌血症病例，其中293例（42.9%）为极老年患者，390例（57.1%）为成年及老年患者。与成年及老年患者相比，极老年患者中内科病房住院、慢性肾功能衰竭、导尿管留置及外周肠外营养（Peripheral Parenteral Nutrition, PPN）的占比更高。极老年患者接受恰当抗真菌治疗（73.2%）与拔除中心静脉导管（Central Venous Catheter, CVC，67.6%）的比例均低于成年及老年患者（分别为82.5%与80%，p<0.002，p<0.004）。极老年患者的30天死亡率高于成年及老年患者（47.8% vs. 23.6%，p<0.0001）。
在成年及老年患者中，死亡的独立危险因素包括年龄（比值比（Odds Ratio, OR）=1.04，95%置信区间（Confidence Interval, CI）：1.00~1.09，p=0.038）、近期化疗史（OR=22.01，95%CI：3.12~155.20，p=0.002）及脓毒症严重程度（OR=40.68，95%CI：7.42~223.10，p<0.001）；拔除中心静脉导管与更高的生存概率相关（OR=0.10，95%CI：0.03~0.33，p<0.001）。
在极老年患者中，死亡的独立危险因素为外周肠外营养（PPN，OR=3.5，95%CI：1.17~10.47，p=0.025）及内科病房住院（OR=2.58，95%CI：1.02~6.53，p=0.046），而拔除中心静脉导管与生存改善相关（OR=0.40，95%CI：0.16~1.00，p=0.050）。
结论：极老年患者的30天死亡率较高，且与念珠菌血症管理不充分相关，尤其在内科病房住院的患者中更为显著。