Has the Epidemiology of Nosocomial Candidemia Changed?

Infect Control Hosp Epidemiol. 2004 Aug;25(8):628-33. doi: 10.1086/502452.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antifungal Agents / therapeutic use
  • Candidiasis / drug therapy
  • Candidiasis / epidemiology*
  • Case-Control Studies
  • Cross Infection / drug therapy
  • Cross Infection / epidemiology
  • Fungemia / drug therapy
  • Fungemia / epidemiology*
  • Hospitals / statistics & numerical data
  • Humans
  • Length of Stay / statistics & numerical data
  • Missouri / epidemiology
  • Multivariate Analysis
  • Retrospective Studies
  • Risk Factors

Substances

  • Antifungal Agents