Secular Trends of Candidemia Over 12 Years in Adult Patients at a Tertiary Care Hospital

Abstract

The incidence of fungal infections has been increasing for the last 3 decades, especially among neutropenic, cancer, and critically ill patients. These infections are associated with high mortality rates. We retrospectively reviewed medical charts of adult patients with fungemia from 1989 to 2000 at our institution. The characteristics of the population groups served by the hospital were described. Of 328 patients with fungemia, we reviewed 315 (96%) medical records, and focused on those with candidemia (n = 294). The species distribution in patients with candidemia showed that the most commonly identified species were Candida albicans (66%), followed by C. glabrata (17%), and C. parapsilosis (6%). The incidence of candidemia ranged from 0.2 to 0.46 per 10,000 patient-days with the highest incidence in 1993 and the lowest in 1997. Although most studies show an increased incidence of candidemia, we observed a reduction over the study period. Furthermore, we observed no shift from C. albicans to non-albicans Candida species despite a significant increase in the use of fluconazole. The overall mortality among patients with candidemia was 44%, with the highest rate in patients over 65 years (52%). Factors independently associated with higher mortality were patient age greater than 65 years, intensive care unit admission, and underlying cancer.

Development and validation of a risk model for identification of non-neutropenic, critically ill adult patients at high risk of invasive Candida infection: the Fungal Infection Risk Evaluation (FIRE) Study

“…Incidence rates of critical care unit candidaemia in previous studies have varied from 1.1 to 94 cases per 1000 admissions, depending upon the geographic location of the unit, setting and inclusion criteria for the study. 25,[51][52][53][54][55][56] The rate of IFD in blood in the present study, at 3.5 per 1000 admissions, is similar to that of other European critical care units. 51,54,57 A previous hospital-wide surveillance from six sentinel hospitals in the UK identified that 45% of candidaemia was reported from the critical care unit, corresponding with an incidence of 7.4 per 1000 admissions.…”

Epidemiology of Candidemia in Brazil: a Nationwide Sentinel Surveillance of Candidemia in Eleven Medical Centers

“…In contrast, we report a high proportion of C. tropicalis (21%) candidemia, even in neonates. European and North American series have consistently reported low proportions of C. tropicalis candidemia (2 to 10% in Europe and 10 to 12% in the United States and Canada) (3,4,6,13,16,22,26,28,30,37,42,47,50,51), whereas higher proportions were observed in a study from Saudi Arabia (20.7%) (1). In our study, the proportion varied from 16 to 29% among the different centers.…”

“…Likewise, an increasing incidence of candidemia in Iceland has been observed during the period between 1980 and 1999 (6). On the other hand, data obtained from a national surveillance study conducted in Swiss tertiary-care hospitals suggested that the incidence of candidemia remained unchanged during the period of 1991 to 2000 (28), while a singlecenter study from Switzerland reported decreasing incidence rates (16). It seems therefore that differences do exist in the epidemiology of candidemia between different countries, underscoring the need for continuous surveillance to monitor trends in incidence, species distribution, and antifungal drug susceptibility profiles.…”

Incidencia y prevalencia de candidemia en pacientes críticamente enfermos en Colombia

“…Existen diversos reportes describiendo a las especies de Candida entre los cinco aislados más frecuentes en hemocultivos en infecciones intrahospitalarias en Estados Unidos de América (E.U.A.) y países desarrollados 1 . Su incidencia varía entre 0,035 y 0,15/1.000 pacientes/día de estancia hospitalaria (DEH), en series norteamericanas y europeas [2][3][4] .…”