title: Secular trends of candidemia over 12 years in adult patients at a tertiary care hospital.
abstract: The incidence of fungal infections has been increasing for the last 3 decades, especially among neutropenic, cancer, and critically ill patients. These infections are associated with high mortality rates. We retrospectively reviewed medical charts of adult patients with fungemia from 1989 to 2000 at our institution. The characteristics of the population groups served by the hospital were described. Of 328 patients with fungemia, we reviewed 315 (96%) medical records, and focused on those with candidemia (n = 294). The species distribution in patients with candidemia showed that the most commonly identified species were Candida albicans (66%), followed by C. glabrata (17%), and C. parapsilosis (6%). The incidence of candidemia ranged from 0.2 to 0.46 per 10,000 patient-days with the highest incidence in 1993 and the lowest in 1997. Although most studies show an increased incidence of candidemia, we observed a reduction over the study period. Furthermore, we observed no shift from C. albicans to non-albicans Candida species despite a significant increase in the use of fluconazole. The overall mortality among patients with candidemia was 44%, with the highest rate in patients over 65 years (52%). Factors independently associated with higher mortality were patient age greater than 65 years, intensive care unit admission, and underlying cancer.
authors.affiliation: Department of Internal Medicine, University of Geneva Hospital, Switzerland.
authors.forename: Jorge
authors.initials: J
authors.lastname: Garbino
authors.forename: Lenka
authors.initials: L
authors.lastname: Kolarova
authors.forename: Peter
authors.initials: P
authors.lastname: Rohner
authors.forename: Daniel
authors.initials: D
authors.lastname: Lew
authors.forename: Peter
authors.initials: P
authors.lastname: Pichna
authors.forename: Didier
authors.initials: D
authors.lastname: Pittet
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D015984:Causality; D015897:Comorbidity; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D004363:Drug Utilization / Q000639:trends; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D016469:Fungemia / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000639:trends*; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D017053:Infection Control; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D012189:Retrospective Studies; D016019:Survival Analysis; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole