Increase in prevalence of nosocomial non-Candida albicans candidaemia and the association of Candida krusei with fluconazole use

Candida is an important nosocomial pathogen. This study was undertaken to provide information on the rate of candidaemia, to define the risks for candidaemia and to describe and account for the epidemiology of candidaemia at our institution between 1992 and 1999. The overall rate was 0.052 per 1000 patient days and 0.27 per 1000 discharges. The major risks for candidaemia were colonization at a non-sterile site (OR 3.85, 95%CI 1.80-9.09), total parenteral nutrition (TPN) in the absence of neutropenia (OR 11.8, 95%CI 4.5-35.4, P<0.001) and neutropenia in the absence of TPN (OR 3.7, 95%CI 1.8-7.7, P<0.001). There was no change in the overall incidence of candidaemia but there was a steady decline in the rate of C. albicans with a corresponding rise in the incidence of non-C. albicans species. C. krusei was highly associated with fluconazole exposure (chi(2) =20.78, P<0.001). There eras no evidence of spread of C. krusei using random amplification of polymorphic DNA, suggesting the appearance of this organism was due to the selection pressure exerted by fluconazole. (C) 2001 The Hospital Infection Society.