Has the epidemiology of nosocomial candidemia changed?
OBJECTIVE
To assess changes in the epidemiology of nosocomial candidemia in the post-fluconazole era among hospitalized patients using a case-control study design.


METHODS
Candidemia case-patients were matched 1:1 on diagnosis, age, and length of stay with control-patients. Conditional logistic regression was used to determine predictors and outcomes of candidemia. Treatment regimens and compliance with national practice guidelines were compared among case-patients.


METHODS
Barnes-Jewish Hospital, a 1,278-bed, tertiary-care center affiliated with Washington University School of Medicine, St. Louis, Missouri.


METHODS
Patients admitted from January 1 to December 31, 2000. Case-patients were identified through the hospital microbiological surveillance system and matched with control-patients.


RESULTS
Predictors of candidemia included Hickman catheters (odds ratio [OR], 9.53; 95% confidence interval [CI95], 1.34 to 68.01), gastric acid suppressants (OR, 6.38; CI95, 2.33 to 17.43), nasogastric tubes (OR, 3.69; CI95, 1.27 to 10.78), antibiotics (OR, 1.46; CI95, 1.15 to 1.86), and admission to the intensive care unit (OR, 6.40; CI95, 2.12 to 19.31). The crude case-fatality rate was 40%. Seventeen (15%) of the case-patients received the recommended treatment regimen according to recently published practice guidelines.


CONCLUSIONS
The epidemiology of candidemia has changed little at our hospital during the past decade and remains a significant cause of mortality. Further studies on the benefits of preventive therapy will be essential to improve the outcome of this infection.
Puzniak
Laura
L
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA.
Teutsch
Steven
S
Powderly
William
W
Polish
Louis
L
D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology*; D016022:Case-Control Studies; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology; D016469:Fungemia / Q000188:drug therapy / Q000453:epidemiology*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008923:Missouri / Q000453:epidemiology; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors
D000935:Antifungal Agents