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Has the Epidemiology of Nosocomial Candidemia Changed?

  • Laura Puzniak (a1) (a2), Steven Teutsch (a3), William Powderly (a1) and Louis Polish (a1)

Abstract

Objective:

To assess changes in the epidemiology of nosocomial candidemia in the post-fluconazole era among hospitalized patients using a case–control study design.

Design:

Candidemia case-patients were matched 1:1 on diagnosis, age, and length of stay with control-patients. Conditional logistic regression was used to determine predictors and outcomes of candidemia. Treatment regimens and compliance with national practice guidelines were compared among case-patients.

Setting:

Barnes-Jewish Hospital, a 1,278-bed, tertiary-care center affiliated with Washington University School of Medicine, St. Louis, Missouri.

Participants:

Patients admitted from January 1 to December 31, 2000. Case-patients were identified through the hospital microbiological surveillance system and matched with control-patients.

Results:

Predictors of candidemia included Hickman catheters (odds ratio [OR], 9.53; 95% confidence interval [CI95], 1.34 to 68.01), gastric acid suppressants (OR, 6.38; CI95, 2.33 to 17.43), nasogastric tubes (OR, 3.69; CI95, 1.27 to 10.78), antibiotics (OR, 1.46; CI95,1.15 to 1.86), and admission to the intensive care unit (OR, 6.40; CI95, 2.12 to 19.31). The crude case-fatality rate was 40%. Seventeen (15%) of the case-patients received the recommended treatment regimen according to recently published practice guidelines.

Conclusions:

The epidemiology of candidemia has changed little at our hospital during the past decade and remains a significant cause of mortality. Further studies on the benefits of preventive therapy will be essential to improve the outcome of this infection.

Copyright

Corresponding author

St. Louis County Department of Health, 111 South Meramec St., Clayton, MO 63105

References

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1.Beck-Sague, C, Jarvis, WR. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980-1990. J Infect Dis 1993;167:12471251.
2.Edmond, MB, Wallace, SE, McClish, DK, Pfaller, MA, Jones, RN, Wenzel, RP. Nosocomial bloodstream infections in United States hospitals: a three year analysis. Clin Infect Dis 1999;29:239244.
3.Wright, WL, Wenzel, RP. Nosocomial candidemia: epidemiology, transmission and prevention. Infect Dis Clin North Am 1997;11:411425.
4.Viscoli, C, Girmenia, C, Marinus, A, et al.Candidemia in cancer patients: a prospective, multicenter surveillance study by the Invasive Fungal Infection Group (IFIG) of the European Organization for Research and Treatment of Cancer (EORTC). Clin Infect Dis 1999;28:10711079.
5.Abi-Said, D, Anaissie, E, Uzun, O, Raad, I, Pinzcowski, H, Vartivarian, S. The epidemiology of hematogenous candidiasis caused by different Candida species. Clin Infect Dis 1997;24:11221128.
6.Pfaller, MA. Nosocomial candidiasis: emerging species, reservoirs and modes of transmission. Clin Infect Dis 1996;22(suppl):S89S94.
7.Pittet, D, Wenzel, RP. Nosocomial bloodstream infections. Arch Intern Med 1995;155:11771184.
8.Pfaller, M, Messer, SA, Houston, A, et al.National Epidemiology of Mycoses Survey: a multicenter study of strain variation and antifungal susceptibility among isolates of Candida species. Diagn Microbiol Infect Dis 1998;31:289296.
9.Rangel-Frausto, MS, Wiblin, T, Blumberg, HM, et al.National Epidemiology of Mycoses Survey (NEMIS): variations in rates of bloodstream infections due to Candida species in seven surgical intensive care units and six neonatal intensive care units. Clin Infect Dis 1999;29:253258.
10.Trick, WE, Fridkin, SK, Edwards, JR, et al.Secular trend of hospital-acquired candidemia among intensive care unit patients in the United States during 1989-1999. Clin Infect Dis 2002;35:627630.
11.Nguyen, MH, Peacock, JE JrMorris, AJ, et al.The changing face of candidemia: emergence of non-Candida albicans species and antifungal resistance. Am J Med 1996;100:617623.
12.Wey, SB, Mori, M, Pfaller, MA, Woolson, RF, Wenzel, RP. Risk factors for hospital-acquired candidemia: a matched case-control study. Arch Intern Med 1989;149:23492353.
13.Goodrich, JM, Reed, EC, Mori, M, et al.Clinical features and analysis of risk factors for invasive candidal infection after marrow transplantation. J Infect Dis 1991;164:731740.
14.Komshian, S, Uwaydah, AK, Sobel, JD, Crane, LR. Fungemia caused by Candida species and Torulopsis glabrata in the hospitalized patient: frequency, characteristics, and evaluation of factors influencing outcome. Rev Infect Dis 1989;11:379390.
15.Vazquez, JA, Sanchez, V, Dmuchowski, C, Dembry, LM, Sobel, JD, Zervos, MJ. Nosocomial acquisition of Candida albicans: an epidemiologic study. J Infect Dis 1993;168:195201.
16.Richet, HM, Andremont, A, Tancrede, C, et al.Risk factors for candidemia in patients with acute lymphocytic leukemia. Rev Infect Dis 1991;13:211215.
17.Pagano, L, Antinori, A, Ammassari, A, et al.Retrospective study of candidemia in patients with hematological malignancies: clinical features, risk factors and outcome of 76 episodes. Eur J Haematol 1999;63:7785.
18.Nieto-Rodriguez, JA, Kusne, S, Manez, R, et al.Factors associated with the development of candidemia and candidemia-related death among liver transplant recipients. Ann Surg 1996;223:7076.
19.Fraser, VJ, Jones, M, Dunkel, J, Storfer, S, Medoff, G, Dunagan, WC. Candidemia in a tertiary care hospital: epidemiology, risk factors and predictors of mortality. Clin Infect Dis 1992;15:414421.
20.Knaus, WA, Draper, EA, Wagner, DP, et al.APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818829.
21.Tryba, M, Cook, DJ. Gastric alkalinization, pneumonia, and systemic infections: the controversy. Scand J Gastroenterol 1995;30(suppl 210):5359.
22.Garvey, BM, McCambley, JA, Tuxen, DV. Effects of gastric alkalinization on bacterial colonization in critically ill patients. Crit Care Med 1989;17:211216.
23.Heyland, DK, Cook, DJ, Schoenfeld, PS, Frietag, A, Varon, J, Wood, G. The effect of acidified enteral feeds on gastric colonization in critically ill patients: results of a multicenter randomized trial. Crit Care Med 1999;27:23992406.
24.Chocarro Martinez, A, Galindo Tobal, F, Ruiz-Irastorza, G, et al.Risk factors for esophageal candidiasis. Eur J Clin Microbiol Infect Dis 2000;19:96100.
25.Larner, AJ, Lendrum, R. Oesophageal candidiasis after omeprazole therapy. Gut 1992;33:860861.
26.Deitch, EA, Morrison, J, Berg, R, Specian, RD. Effect of hemorrhagic shock on bacterial translocation, intestinal morphology and intestinal permeability in conventional and antibiotic-decontaminated rats. Crit Care Med 1990;18:529536.
27.Reed, L, Martin, M, Manglano, R, et al.Bacterial translocation following abdominal trauma in humans. Circulatory Shock 1994;42:16.
28.Berg, RD, Womack, E, Deitch, EA. Immunosuppression and intestinal bacterial overgrowth synergistically promote bacterial translocation. Arch Surg 1988;123:13591364.
29.Alverdi, JC, Aoys, E, Moss, GS. Total parenteral nutrition promotes bacterial translocation from the gut. Surgery 1988;104:185190.
30.MacFie, J, O'Boyle, C, Mitchell, CJ, Buckley, PM, Johnstone, D, Sudworth, P. Gut origin of sepsis: a prospective study investigating associations between bacterial translocation, gastric microflora, and septic morbidity. Gut 1999;45:223228.
31.Eaves-Pyles, T, Alexander, JW. Comparison of translocation of different types of microorganisms from the intestinal tract of burned mice. Shock 2001;16:148152.
32.Diekema, DJ, Messer, SA, Brueggemann, AB, et al.Epidemiology of candidemia: 3 year results from the emerging infections and the Epidemiology of Iowa Organisms study. J Clin Microbiol 2002;40:12981302.
33.Weems, JJ. Candida parapsilosis: epidemiology, pathogenicity, clinical manifestations, and antimicrobial susceptibility. Clin Infect Dis 1992;14:756766.
34.Girmenia, C, Martino, P, De Bernardis, F, et al.Rising incidence of Candida parapsilosis fungemia in patients with hematologic malignancies: clinical aspects, predisposing factors, and differential pathogenicity of the causative strains. Clin Infect Dis 1996;23:506514.
35.Rex, JH, Walsh, TJ, Sobel, JD, et al.Practice guidelines for the treatment of candidiasis. Clin Infect Dis 2000;30:662678.
36.Fichtenbaum, CJ, German, M, Dunagan, WC, et al.A pilot study of the management of uncomplicated candidemia with a standardized protocol of amphotericin B. Clin Infect Dis 1999;29:15511556.

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