Current trends in nosocomial candidemia: Results of a large multienter study

Academic Article

Abstract

  • To better define the current epidemiology and therapeutic approaches to candidemia, the NIAID Mycoses Study Group Candidiasis Subproject is conducting a prospective surveillance study at 37 participating centers in the U.S. Since 10/95,1078 patients have been enrolled and complete data is available in 644. 583 pts (91%) are > 12 yrs (ADULT) and 61 pts ≤ 12-y-old (PEDS). 335 (52%) are male. Common risk factors were central venous catheters (83%), urinary catheters (58%), TPN (50%), intubation (46%), surgery (34%), and malnutrition (32%). Median age was 1 month for PEDS and 56 y for ADULT. Mean APACHE n score was 18.5 for ADULT. Species distribution varied significantly by age, P = .001 by Χ2 (Table). Of all pts, 6% had more than one Candida sp. in blood, and 16% had concomitant bacteremia. Median duration of Candida was 4 days. Most pts received antifungal therapy with AMB, fluconazole, or Candida sp. PEDS ADULT AMB followed by flu. Three months albicans 49% 46% after the index positive blood culture, parapsilosis 36% 11% 42% (ADULT) and 65%(PEDS) glabrata 5% 19% were alive with a resolved infection. tropicalis 5% 13% Death occurred in 41 % (ADULT) and 26% (PEDS) and was judged due to Candida in 24% (ADULT) and 44% (PEDS). Conclusions: The epidemiology of Candida blood stream infections continues to evolve, and C. albicans now represents less than half of the blood isolates. Species distribution is different between ADULT and PEDS. Due to the known species-related variations in antifungal drug susceptibility, virulence, and pathogenesis, this information may affect the design of future antifungal trials.
  • Published In

    Author List

  • Pappas PG; Rex JH; Hamill RJ; Larsen RA; Powderly WG; Horowttz H; Kauffman CA; Chapman SW; Lee J
  • Start Page

  • 357
  • Volume

  • 25
  • Issue

  • 2