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Has the Epidemiology of Nosocomial Candidemia Changed?

Published online by Cambridge University Press:  02 January 2015

Laura Puzniak ,
Steven Teutsch ,
William Powderly  and
Louis Polish
Laura Puzniak*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri St. Louis County Department of Health, St. Louis, Missouri
Steven Teutsch
Affiliation:
Merck & Co., Inc., West Point, Pennsylvania
William Powderly
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
Louis Polish
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
*
St. Louis County Department of Health, 111 South Meramec St., Clayton, MO 63105
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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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 8 , August 2004 , pp. 628 - 633
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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