The changing epidemiology of healthcare-associated candidemia over three decades

被引:234
|
作者
Diekema, Daniel [1 ,2 ]
Arbefeville, Sophie [3 ]
Boyken, Linda [2 ]
Kroeger, Jennifer [2 ,4 ]
Pfaller, Michael [2 ,4 ,5 ]
机构
[1] Univ Iowa, Dept Med, Carver Coll Med, Div Infect Dis, Iowa City, IA 52242 USA
[2] Univ Iowa, Dept Pathol, Carver Coll Med, Div Med Microbiol, Iowa City, IA 52242 USA
[3] Univ Minnesota, Dept Lab Med & Pathol, Minneapolis, MN 55414 USA
[4] Univ Iowa, Coll Publ Hlth, Dept Epidemiol, Iowa City, IA 52242 USA
[5] JMI Labs, N Liberty, IA 52317 USA
关键词
Candidemia; Echinocandin; Epidemiology; HOSPITAL-ACQUIRED CANDIDEMIA; ATTRIBUTABLE MORTALITY; INFECTIONS; SUSCEPTIBILITY; SURVEILLANCE; CASPOFUNGIN; GLABRATA; RISK;
D O I
10.1016/j.diagmicrobio.2012.02.001
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
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 athicans, 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%, 3nd 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 mu g/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. (C) 2012 Elsevier Inc. All rights reserved.
引用
收藏
页码:45 / 48
页数:4
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