Hostname: page-component-848d4c4894-m9kch Total loading time: 0 Render date: 2024-06-04T00:13:30.128Z Has data issue: false hasContentIssue false
  • English
  • Français

Secular Trends in the Epidemiology of Nosocomial Fungal Infections at a Teaching Hospital in Taiwan, 1981 to 1993

Published online by Cambridge University Press:  02 January 2015

Mary D. Nettleman ,
Yee-Chun Chen ,
Shan-Chwen Chang ,
Chun-Chuan Sun ,
Li-Se Yang ,
Wei-Chuan Hsieh  and
Kwen-Tay Luh
Yee-Chun Chen
Affiliation:
Departments of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
Shan-Chwen Chang*
Affiliation:
Nursery, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
Chun-Chuan Sun
Affiliation:
Nursery, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
Li-Se Yang
Affiliation:
Nursery, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
Wei-Chuan Hsieh
Affiliation:
Departments of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
Kwen-Tay Luh
Affiliation:
Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
*
Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, Taiwan 10016, ROC
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To describe the incidence and patterns of nosocomial fungal infection in a large teaching hospital in Taiwan.

Design:

Prospective, hospitalwide nosocomial surveillance data from 1981 through 1993 were analyzed to show the secular trend in nosocomial fungal infection rates and to identify the most common pathogens and sites of infection (other than skin) in this hospital.

Setting and Patients:

The National Taiwan University Hospital is a medical school-affiliated hospital in the city of Taipei, Taiwan, with a 1,200-bed capacity before 1991 and 1,500 beds since 1992. It provides both primary and tertiary medical care.

Results:

The overall nosocomial fungal infection rate rose from 0.9 infections per 1,000 discharges in 1981 to 6.6 per 1,000 discharges in 1993, with the highest rate at the medical intensive-care unit (26.5/1,000 discharges in 1993). This increase in infection rate was found at four major anatomic sites of infection, particularly including the bloodstream (0.08-2.19/1,000 discharges) and the urinary tract (0.36-2.95/1,000 discharges). Of 256 pathogens causing nosocomial fungemia from 1981 through 1993, Candida albicans was the most commonly isolated (50.8%), followed by Candida tropicalis (17.6%), Candida parapsilosis (11.7%), and Candida glabrata (8.2%). As compared to isolates from 1981 through 1988, the proportion of C parapsilosis and C glabrata isolated between 1989 and 1993 increased more than sixfold and fourfold, respectively. The increasing importance of fungal infections was confirmed further by the increased use of amphotericin B and azoles in this hospital.

Conclusions:

Candida species and other yeasts have become a prominent cause of nosocomial infections in this hospital. These fungal pathogens accounted for a higher proportion of nosocomial bloodstream and urinary infections than any single bacterial species. Therefore, it is important to conduct a prospective epidemiological study and to establish in vitro antifungal susceptibility testing to enhance efforts to control nosocomial fungal infections and to minimize the risk of emergence of antifungal resistance.

Type
The International Perspective
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 5 , May 1997 , pp. 369 - 375
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Anaissie, E, Bodey, GP. Nosocomial fungal infections—old problems and new challenges. Infect Dis Clin North Am 1989;3:867–882.CrossRefGoogle ScholarPubMed
2. Wey, SB, Mori, M, Pfaller, MA, Woolson, RF, Wenzel, RP. Hospital-acquired candidemia—the attributable mortality and excess length of stay. Arch Intern Med 1988;148:2642–2645.CrossRefGoogle ScholarPubMed
3. Beck-Saque, CM, Jarvis, WR, the National Nosocomial Infections Surveillance System. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980-1990. J Infect Dis 1993;167:1247–1251.Google Scholar
4. Banerjee, SN, Emori, TG, Culver, DH, et al. Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989. Am J Med 1991;91(suppl 3B):86–89.CrossRefGoogle ScholarPubMed
5. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
6. Murray, PR. Comparison of the lysis-centrifugation and agitated biphasic blood culture systems for detection of fungemia. J Clin Microbiol 1991;29:96–98.CrossRefGoogle ScholarPubMed
7. Walsh, TJ, Jarosinski, PF, Fromtling, RA. Increasing usage of systemic antifungal agents. Diagn Microbiol Infect Dis 1990;13:37–40.CrossRefGoogle ScholarPubMed
8. Perfect, JR, Pickard, WW, Hunt, DL, Palmer, B, Schell, WA. The use of amphotericin B in nosocomial fungal infection. Rev Infect Dis 1991;13:474–479.CrossRefGoogle ScholarPubMed
9. Pfaller, M, Wenzel, R. Impact of the changing epidemiology of fungal infections in the 1990s. Eur J Clin Microbiol Infect Dis 1992;11:287–291.CrossRefGoogle ScholarPubMed
10. Schwartz, RS, Mackintosh, FR, Schrier, SL, Greenberg, PL. Multivariate analysis of factors associated with invasive fungal disease during remission induction therapy for acute myelogenous leukemia. Cancer 1984;53:411–419.3.0.CO;2-E>CrossRefGoogle ScholarPubMed
11. Wey, SB, Mori, M, Pfaller, MA, Wolson, RF, Wenzel, RP. Risk factors for hospital-acquired candidemia: a matched case-control study. Arch Intern Med 1989;149:2349–2353.CrossRefGoogle ScholarPubMed
12. Wingard, JR. Importance of Candida species other than C albicans as pathogens in oncology patients. Clin Infect Dis 1995;20:115–125.CrossRefGoogle Scholar
13. Vartivarian, SE, Anaissie, E, Bodey, GP. Emerging fungal pathogens in immunocompromised patients: classifications, diagnosis, and management. Clin Infect Dis 1993;17(suppl 2):487–491.CrossRefGoogle ScholarPubMed
14. Aisner, J, Murillo, J, Schimpff, SC, Steere, AC. Invasive aspergillosis in acute leukemia: correlation with nose cultures and antibiotic use. Ann Intern Med 1979;90:4.CrossRefGoogle ScholarPubMed
15. Gualtieri, RJ, Donowitz, GR, Kaiser, DL, Hess, CE, Sande, MA. Double-blind randomized study of prophylactic trimethoprim/sulfamethoxazole in granulocytopenic patients with hematological malignancies. Am J Med 1983;74:934–940.CrossRefGoogle Scholar
16. Bross, J, Talbot, GH, Maislin, G, Hurwitz, S, Strom, B. Risk factors for nosocomial candidemia: a case-control study in adults without leukemia. Am J Med 1989;87:614–620.CrossRefGoogle ScholarPubMed
17. Weems, JJ Jr. Candida parapsilosis: epidemiology, pathogenicity, clinical manifestations, and antimicrobial susceptibility. Clin Infect Dis 1992;14:756–766.CrossRefGoogle ScholarPubMed
18. Kerridge, D, Nicholas, RO. Drug resistance in the opportunistic pathogens Candida albicans and Candida glabrata . J Antimicrob Chemother 1986;18(suppl B):39–49.CrossRefGoogle ScholarPubMed
19. Warnock, DW, Burke, J, Cope, NJ, Johnson, EM, von Fraunhofer, NA, Williams, EW. Fluconazole resistance in Candida glabrata . Lancet 1988;i:1310.CrossRefGoogle Scholar
20. Kiehn, TE, Gorey, E, Brown, AE, Edwards, FF, Armstrong, D. Sepsis due to Rhodotorula related to use of indwelling central venous catheters. Clin Infect Dis 1992;14:841–846.CrossRefGoogle ScholarPubMed
21. Goldman, M, Pottage, JC Jr, Weaver, DC. Candida krusei fungemia: report of 4 cases and review of the literature. Medicine 1993;72:143–150.CrossRefGoogle ScholarPubMed
22. Walsh, TJ, Melcher, GP, Rinaldi, MG, et al. Trichosporon beigelii, an emerging pathogen resistant to amphotericin B. J Clin Microbiol 1990;28:1616–1622.CrossRefGoogle ScholarPubMed
23. Wingard, JR, Merz, WG, Rinaldi, MG, Johnson, TR, Karp, JE, Saral, R. Increase in Candida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole. N Engl J Med 1991;325:1274–1277.CrossRefGoogle ScholarPubMed
24. Goodman, JL, Winston, DJ, Greenfield, RA, et al. A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation. N Engl J Med 1992;326:845–851.CrossRefGoogle ScholarPubMed
25. Powderly, WG, Kobayashi, GS, Herzig, GP, Medoff, G. Amphotericin B-resistant yeast infection in severely immunocompromised patients. Am J Med 1988;84:826–832.CrossRefGoogle ScholarPubMed
26. Drutz, DJ, Lehrer, RI. Development of amphotericin B-resistant Candida tropicalis in a patient with defective leukocyte function. Am J Med Sci 1978;276:77–92.CrossRefGoogle Scholar
27. Blinkhorn, RJ, Adelstein, D, Spagnuolo, PJ. Emergence of a new opportunistic pathogens, Candida lusitaniae . J Clin Microbiol 1989;27:236–240.CrossRefGoogle Scholar
28. Guinet, R, Chanas, J, Goullier, A, Bonnefoy, G, Ambroise-Thomas, P. Fatal septicemia due to amphotericin B-resistant Candida lusitaniae . J Clin Microbiol 1983;18:443–444.CrossRefGoogle ScholarPubMed
29. Merz, WG. Candida lusitaniae: frequency of recovery, colonization, infection, and amphotericin B resistance. J Clin Microbiol 1984;20:1194–1195.CrossRefGoogle ScholarPubMed
30. Kick, JD, Rosengard, BR, Merz, WG, Stuart, RK, Hutchins, GM, Saral, R. Fatal disseminated candidiasis due to amphotericin Bresistant Candida guilliermondii . Ann Intern Med 1985;102:67–68.Google Scholar
31. Seidenfeld, SM, Cooper, BH, Smith, JW, Luby, JP, Mackowiak, PA. Amphotericin B tolerance: a characteristic of Candida parapsilosis not shared by other Candida species. J Infect Dis 1983;147:116–119.CrossRefGoogle Scholar
32. Newman, SL, Flanigan, TP, Fisher, A, Rinaldi, MG, Stein, M, Vigilante, K. Clinically significant mucosal candidiasis resistant to fluconazole treatment in patients with AIDS. Clin Infect Dis 1994;19:684–686.CrossRefGoogle ScholarPubMed
33. Sanguineti, A, Carmichael, JK, Campbell, K. Fluconazoleresistant Candida albicans after long-term suppressive therapy. Arch Intern Med 1993;153;1122–1124.CrossRefGoogle Scholar
34. Cameron, ML, Schell, WA, Bruch, S, Bartlett, JA, Waskin, HA, Perfect, JR. Correlation of in vitro fluconazole resistance of Candida isolates in relation to therapy and symptoms of individuals seropositive for human immunodeficiency virus type 1. Antimicrob Agents Chemother 1993;37:2449–2453.CrossRefGoogle ScholarPubMed
35. Boken, DJ, Swindells, S, Rinaldi, MG. Fluconazole-resistant Candida albicans . Clin Infect Dis 1993;17:1018–1021.CrossRefGoogle ScholarPubMed
36. Ruhnke, M, Eigler, A, Tennagen, I, Geiseler, B, Engelmann, E, Trautmann, M. Emergence of fluconazole-resistant strains of Candida albicans in patients with recurrent oropharyngeal candidosis and human immunodeficiency virus infection. J Clin Microbiol 1994;32:2092–2098.CrossRefGoogle ScholarPubMed
37. Chang, SC, Hsieh, WC, Luh, KT. Resistance to antimicrobial agents of common bacteria isolated from Taiwan. Int J Antimicrob Agents 1994;4:143–146.CrossRefGoogle Scholar
38. Cohen, ML. Epidemiology of drug resistance: implications for a post-antimicrobial era. Science 1992;257:1050–1055.CrossRefGoogle ScholarPubMed
39. Neu, HC. The crisis in antibiotic resistance. Science 1992;257:1064–1073.CrossRefGoogle ScholarPubMed
40. Kunin, CM. Resistance to antimicrobial drugs—a worldwide calamity. Ann Intern Med 1993;118:557–561.CrossRefGoogle ScholarPubMed
41. Pfaller, MA. Epidemiology and control of fungal infection. Clin Infect Dis 1994;19(suppl 1):8–13.CrossRefGoogle Scholar