National Epidemiology of Mycoses Survey: A Multicenter Study of Strain Variation and Antifungal Susceptibility Among Isolates of Candida Species

Pfaller, Michael A.; Messer, S. A.; Houston, A.; Rangel‐Frausto, M. Sigfrido; Wiblin, Todd; Blumberg, Henry M.; Edwards, John E.; Jarvis, William R.; Martin, Michael A.; Neu, Harold C.; Saiman, Lisa; Patterson, Jan E.; Dibb, J. C.; Roldán, Cristina; Rinaldi, Michael G.; Wenzel, Richard P.

doi:10.1016/s0732-8893(97)00245-9

Cited by 126 publications

(89 citation statements)

References 24 publications

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“…Furthermore, it confirms the results of previous reports [10][11][12] of the increasing proportions of nonCandida albicans species as agents of candidemia. Approximately 30% of bloodstream infections due to Candida species in this study were caused by non-C. albicans species.…”

Section: Discussionsupporting

confidence: 91%

Candidemia at a University Hospital: Epidemiology, Risk Factors and Predictors of Mortality

Akbar

Tahawi

2001

Annals of Saudi Medicine

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Background: Blood stream infection due to Candida species are becoming increasingly important causes of morbidity and mortality in hospitalized patients. The aim of this study was to obtain epidemiological data on candidemia in patients at King Abdulaziz University Hospital (KAUH), and to discuss the influence of several clinical variables on the development and outcome of candidemia. Materials and Methods: Demographic information, risk factors, therapy and outcome of all patients who had candidemia at KAUH between January 1998 and December 1999 were reviewed. Results: Thirty-one candidemic episodes were identified. All the candidemic episodes were hospital acquired. The most common risk factors to candidemia were central venous catheters (87%), stay in intensive care unit (ICU) (77%), and broad-spectrum antibiotics therapy (74%). Candida albicans was the most frequently isolated species (71%), followed by Candida tropicalis and Candida parapsilosis (13% each). Twenty-six patients (84%) were treated with amphotericin B, 4 (13%) with fluconazole, and one (3%) with ketoconazole. Antifungal susceptibility testing of the isolates in general revealed minimal levels of resistance to amphotericin B (3%) versus 39% resistance to fluconazole. Less than 5% of Candida albicans were resistant to amphotericin B, in comparison with >35% of these strains that were resistant to fluconazole. The overall mortality was 71%. Mortality was significantly associated with the presence of central venous catheters (P=0.001), stay in intensive care unit (P<0.001), and prolonged hospital stay before the onset of candidemia (P=0.05). Conclusion: Despite antifungal treatment, the mortality of candidemia is still high. Rapid changes in the rate of infection, potential risk factors, and emerging species demand continued and close surveillance of this serious infection.

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Section: Discussionsupporting

confidence: 91%

Candidemia at a University Hospital: Epidemiology, Risk Factors and Predictors of Mortality

Akbar

Tahawi

2001

Annals of Saudi Medicine

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“…2 C. albicans has historically been the most frequently isolated species, accounting for approximately 60% to 70% of the infections; however, recent studies have documented an increase in the proportion of infections due to non-albicans species. [1][2][3][4][5][6][7][8][9][10][11] Previous studies have suggested several risk factors for the acquisition of a nosocomial candidal bloodstream infection. 2 These data are somewhat limited by the fact that many of the epidemiologic studies focused on specific patient populations, were observational in nature, and were conducted prior to the era of increased use of azoles.…”

mentioning

confidence: 99%

Has the Epidemiology of Nosocomial Candidemia Changed?

Puzniak

Teutsch

Powderly

et al. 2004

Infect. Control Hosp. Epidemiol.

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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.

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“…has been reported, 19e21 although endogenous colonisation is thought to cause most candidiasis. 19,22,23 Candida colonisation of multiple sites is an independent risk factor for invasive disease and it has been suggested that colonisation of 2 or more non-contiguous sites in a high risk patient is sufficient to initiate treatment. 8,24e26 In this retrospective study, only 31% of patients who developed candidaemia would have received appropriate pre-emptive treatment based on colonisation of 2 non-contiguous sites, whereas 20 patients (48%) would have received either inappropriate or anti-fungal therapy as they had either no colonisation or candidaemia with a fcz-resistant species despite colonisation with fcz-sensitive species.…”

Section: Discussionmentioning

confidence: 99%

Prior colonisation with Candida species fails to guide empirical therapy for candidaemia in critically ill adults

Troughton

Browne

McAuley

et al. 2010

Journal of Infection

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National Epidemiology of Mycoses Survey: A Multicenter Study of Strain Variation and Antifungal Susceptibility Among Isolates of Candida Species

Cited by 126 publications

References 24 publications

Candidemia at a University Hospital: Epidemiology, Risk Factors and Predictors of Mortality

Candidemia at a University Hospital: Epidemiology, Risk Factors and Predictors of Mortality

Has the Epidemiology of Nosocomial Candidemia Changed?

Prior colonisation with Candida species fails to guide empirical therapy for candidaemia in critically ill adults

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