Journal article
The changing epidemiology of healthcare-associated candidemia over three decades
Diagnostic microbiology and infectious disease, Vol.73(1), pp.45-48
05/2012
DOI: 10.1016/j.diagmicrobio.2012.02.001
PMID: 22578938
Abstract
We describe the epidemiology of healthcare-associated candidemia (HAC) in our tertiary care hospital, in comparison with both the pre-fluconazole (pre-FLU) and pre-echinocandin (pre-EC) eras. We identified all patients with HAC using microbiology records from 1/2004 to 12/2007, reviewed medical records, and pulled isolates for testing. We compared mortality, underlying illness, Candida species distribution, and antifungal susceptibility with 2 prior University of Iowa cohorts (88 patients from 1983 to 1986 [pre-FLU], and 108 from 1997 to 2001 [pre-EC]). Of 108 patients with HAC from 2004 to 2007, species distribution was 47% C. albicans, 29% C. glabrata, 12% C. parapsilosis, 6% C. tropicalis, and no C. krusei. Compared with pre-FLU and pre-EC eras, there was a reduction in % C. albicans (from 61% and 60%, respectively), an increase in % C. glabrata (from 0% and 16%), and no change in % C. parapsilosis over time (12% and 12%). In-hospital mortality was lower in 2004–2007 than both pre-FLU and pre-EC (31% versus 57-61%), and 30-day mortality was also lower (33% versus 48% in pre-EC). Mean Charlson index was lower for the 2004–2007 cohort than pre-EC (3.0 versus 3.4)—fewer patients had leukemia or lymphoma (8% versus 16%) or other malignancies (18% versus 24%), while more were surgical patients (58% versus 48%). Using the new Clinical and Laboratory Standards Institute breakpoints for FLU and caspofungin, we found no caspofungin resistance, and FLU resistance only among C. glabrata (15% had FLU MICs >32 µg/mL). The epidemiology of HAC is changing at our hospital, with continued emergence of C. glabrata, fewer cases among oncology patients, and lower in-hospital and 30-day mortality.
Details
- Title: Subtitle
- The changing epidemiology of healthcare-associated candidemia over three decades
- Creators
- Daniel Diekema - Division of Infectious Diseases, Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USASophie Arbefeville - Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55414, USALinda Boyken - Division of Medical Microbiology, Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USAJennifer Kroeger - Division of Medical Microbiology, Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USAMichael Pfaller - Division of Medical Microbiology, Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
- Resource Type
- Journal article
- Publication Details
- Diagnostic microbiology and infectious disease, Vol.73(1), pp.45-48
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.diagmicrobio.2012.02.001
- PMID
- 22578938
- ISSN
- 0732-8893
- eISSN
- 1879-0070
- Grant note
- Merck
- Language
- English
- Date published
- 05/2012
- Academic Unit
- Infectious Diseases; Epidemiology; Pathology; Internal Medicine
- Record Identifier
- 9983986267502771
Metrics
36 Record Views