title: Do clinical features allow for accurate prediction of fungal pathogenesis in bloodstream infections? Potential implications of the increasing prevalence of non-albicans candidemia.
abstract: OBJECTIVE
  To describe the evolving epidemiology of fungal bloodstream infections in critically ill and noncritically ill patients and to identify predictors of infection with non-albicans yeast species.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Two academic, tertiary care centers.
  
  
  METHODS
  All persons during a 4-yr period who developed fungemia.
  
  
  METHODS
  None.
  
  
  RESULTS
  We initially compared subjects with Candida albicans vs. alternative yeast. In a sensitivity analysis, we compared persons with potentially fluconazole-resistant organisms (Candida glabrata and Candida krusei) to those with other fungi. We also repeated these analyses in the subgroup of persons in the intensive care unit when they developed fungemia. The study cohort included 245 patients (60% in the intensive care unit), and C. albicans accounted for 52% of infections, whereas C. glabrata represented 20% of cases. The distribution of isolates was similar in both intensive care unit patients and those on the wards. In the entire population, no variable, including both previous fluconazole exposure and severity of illness, correlated with the fungemia due to a non-albicans species. In our sensitivity analysis, no factor was independently associated with a potentially fluconazole-resistant yeast. For the subgroup of subjects whose fungemia was diagnosed while they were in the intensive care unit, no variable differentiated C. albicans from non-albicans isolates.
  
  
  CONCLUSIONS
  Non-albicans yeast are common both in the intensive care unit and on the wards. Simple clinical factors do not allow the clinician to effectively identify patients likely infected with non-albicans pathogens or with possible fluconazole-resistant fungi.
authors.affiliation: Pulmonary and Critical Care Medicine, Washington Hospital Center, Washington, DC, USA. afshorr@dnamail.com
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Shorr
authors.forename: D Ray
authors.initials: DR
authors.lastname: Lazarus
authors.forename: John H
authors.initials: JH
authors.lastname: Sherner
authors.forename: William L
authors.initials: WL
authors.lastname: Jackson
authors.forename: Matthew
authors.initials: M
authors.lastname: Morrel
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology; D002175:Candida / Q000145:classification* / Q000187:drug effects; D002176:Candida albicans; D041221:Candida glabrata / Q000187:drug effects; D041022:Candida tropicalis; D002177:Candidiasis / Q000453:epidemiology* / Q000382:microbiology*; D016638:Critical Illness; D025141:Drug Resistance, Fungal; D005260:Female; D015725:Fluconazole / Q000494:pharmacology; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole