Candidemia before and during the fluconazole era: prevalence, type of species and approach to treatment in a tertiary care community hospital

Scand J Infect Dis. 2001;33(2):137-9. doi: 10.1080/003655401750065544.

Abstract

The characteristics of candidemia before and after the introduction of fluconazole were compared at our institution. In the pre-fluconazole era (1986-89), the incidence of candidemia rose from 0.02% to 13% over the course of 4 y. Candida albicans accounted for 44/66 isolates (67%) and C. glabrata and C. parapsilosis were the predominant non-albicans species (9% each). In one-third of cases antifungal therapy was not given and the overall mortality rate was 55%. During the fluconazole era (1994-97), the incidence of candidemia remained constant between 1994 and 1996 at 0.09-0.11% and dropped to 0.06% in 1997. Bloodstream infection associated with neutropenia increased significantly but only accounted for 13% of cases; antifungal prophylaxis was not employed. The isolation of C. albicans decreased (n = 49; 50%) whereas isolation of both C. parapsilosis (n = 23; 24%) and C. tropicalis (n = 16; 16%) increased. The vast majority of patients received antifungal therapy and the overall mortality rate was 39%. These findings show that the incidence of candidemia rose steadily prior to the fluconazole era and then stabilized in spite of a shift towards non-albicans species. When candidemia was encountered in the fluconazole era, it was rare not to give antifungal treatment.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antifungal Agents / therapeutic use*
  • Candida* / classification
  • Candidiasis / drug therapy
  • Candidiasis / epidemiology*
  • Candidiasis / microbiology
  • Child
  • Child, Preschool
  • Drug Utilization
  • Fluconazole / therapeutic use*
  • Fungemia / drug therapy
  • Fungemia / epidemiology*
  • Fungemia / microbiology
  • Hospitals, Community
  • Hospitals, Teaching
  • Humans
  • Incidence
  • Infant
  • Middle Aged
  • Opportunistic Infections / drug therapy
  • Opportunistic Infections / epidemiology*
  • Opportunistic Infections / microbiology
  • Prevalence

Substances

  • Antifungal Agents
  • Fluconazole