Secular trends in nosocomial candidaemia in non-neutropenic patients in an Italian tertiary hospital.
A retrospective study was performed in an Italian tertiary hospital to evaluate trends in candidaemia between 1992 and 2001, and to compare the characteristics of episodes of fungaemia between 1992--1997 and 1998--2001. In total, 370 episodes of candidaemia were identified, with an average incidence of 0.99 episodes/10 000 patient-days/year (range 0.49--1.29 episodes). On an annual trend basis, the overall incidence was essentially stable in surgical and medical wards, but decreased in intensive care units (ICUs) (p 0.0065). The average use of fluconazole was 37.9 g/10 000 patient-days/year (range 21.4--56.1 g), and did not change significantly during the 10-year period. Nearly two-thirds of patients were in ICUs at the onset of candidaemia, but none was neutropenic in either study period. Candida albicans remained the predominant species isolated (53.8% vs. 48.1%), followed by Candida parapsilosis, Candida glabrata and Candida tropicalis, the distribution of which did not change significantly. The 30-day crude mortality rate was essentially similar (44% vs. 35%) in both study periods. Thus the incidence of nosocomial candidaemia, although high in this institution, decreased among critically-ill patients during the 10-year period. This finding seemed to be related to an improvement in infection control practices, particularly regarding the prevention of intravascular catheter-related infections in ICUs. Although the overall use of fluconazole was considerable, no increase in azole-resistant non-albicans Candida spp. was detected.
Luzzati
R
R
Department of Infectious Diseases, University Hospital of Verona, Verona, Italy. roberto.luzzati@aots.sanita.fvg.it
Allegranzi
B
B
Antozzi
L
L
Masala
L
L
Pegoraro
E
E
Azzini
A
A
Concia
E
E
D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000145:classification / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology* / Q000382:microbiology*; D002408:Catheters, Indwelling; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D025141:Drug Resistance, Fungal; D015725:Fluconazole / Q000627:therapeutic use; D016469:Fungemia; D006761:Hospitals; D006801:Humans; D015994:Incidence; D017053:Infection Control; D007297:Inpatients; D007362:Intensive Care Units; D007558:Italy / Q000453:epidemiology; D009503:Neutropenia; D012189:Retrospective Studies
D000935:Antifungal Agents; D015725:Fluconazole