title: Active surveillance for candidemia, Australia.
abstract: Population-based surveillance for candidemia in Australia from 2001 to 2004 identified 1,095 cases. Annual overall and hospital-specific incidences were 1.81/100,000 and 0.21/1,000 separations (completed admissions), respectively. Predisposing factors included malignancy (32.1%), indwelling vascular catheters (72.6%), use of antimicrobial agents (77%), and surgery (37.1%). Of 919 episodes, 81.5% were inpatient healthcare associated (IHCA), 11.6% were outpatient healthcare associated (OHCA), and 6.9% were community acquired (CA). Concomitant illnesses and risk factors were similar in IHCA and OHCA candidemia. IHCA candidemia was associated with sepsis at diagnosis (p<0.001), death <30 days after infection (p<0.001), and prolonged hospital admission (p<0.001). Non-Candida albicans species (52.7%) caused 60.5% of cases acquired outside hospitals and 49.9% of IHCA candidemia (p = 0.02). The 30-day death rate was 27.7% in those > or =65 years of age. Adult critical care stay, sepsis syndrome, and corticosteroid therapy were associated with the greatest risk for death. Systematic epidemiologic studies that use standardized definitions for IHCA, OHCA, and CA candidemia are indicated.
authors.affiliation: Westmead Hospital, Westmead, New South Wales, Australia. sharonc@icpmr.wsahs.nsw.gov.au
authors.forename: Sharon
authors.initials: S
authors.lastname: Chen
authors.forename: Monica
authors.initials: M
authors.lastname: Slavin
authors.forename: Quoc
authors.initials: Q
authors.lastname: Nguyen
authors.forename: Deborah
authors.initials: D
authors.lastname: Marriott
authors.forename: E Geoffrey
authors.initials: EG
authors.lastname: Playford
authors.forename: David
authors.initials: D
authors.lastname: Ellis
authors.forename: Tania
authors.initials: T
authors.lastname: Sorrell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D002177:Candidiasis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors