title: Nosocomial candidemia at a general hospital: the change of epidemiological and clinical characteristics. A comparative study of 2 cohorts (1993-1998 versus 2002-2005).
abstract: BACKGROUND
  Nosocomial candidemia (NC) is associated with high mortality, increased hospital stay and greater economical cost.
  
  
  OBJECTIVE
  To evaluate epidemiological and clinical aspects of 2 different cohorts of non-paediatric patients with NC.
  
  
  METHODS
  A retrospective observational and comparative study of patients with NC. Patients were identified by review of results of blood cultures from the hospital microbiology laboratory. We analysed epidemiological, clinical, microbiological and laboratory data and changes in the 2 cohorts: 1993-1998 (P1) and from 2002 to 2005 (P2).
  
  
  RESULTS
  Eighty patients were studied during P1 and 107 during P2; incidence was 9/10,000 in P1 and 15.8/10,000 admitted patients in P2 (p<0.05). Mean age was 52 years in P1 and 61 years in P2 (p<0.05); 66% and 49% NC were due to Candida albicans in P1 and P2, respectively (p<0.05); diabetes was present in 12% in P1 and in 25% in P2 (p<0.05). All of the patients had previously received at least one course of broad-spectrum antibiotics. A statistically significant difference (p<0.05) in predisposing conditions was identified in central intravenous line rate (100% in P1 and 91% in P2) and previous surgery (43% in P1 and 78% in P2). Acute severity of illness at onset and complications were more frequent in P2 (p<0.05). Mortality rate was similar in P1 and P2 (51% and 49.5%, respectively).
  
  
  CONCLUSIONS
  Frequency of NC has increased and non-albicans Candida is now more frequent than C. albicans. Although acute severity of illness at onset and complications are now more frequent, mortality remains the same.
authors.affiliation: Internal Medicine-Infectious Diseases Department, University Hospital Virgen de Arrixaca, Murcia, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Gómez
authors.forename: Elisa
authors.initials: E
authors.lastname: García-Vázquez
authors.forename: Cristina
authors.initials: C
authors.lastname: Espinosa
authors.forename: Joaquín
authors.initials: J
authors.lastname: Ruiz
authors.forename: Manuel
authors.initials: M
authors.lastname: Canteras
authors.forename: Alicia
authors.initials: A
authors.lastname: Hernández-Torres
authors.forename: Victor
authors.initials: V
authors.lastname: Baños
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Herrero
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002177:Candidiasis / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D003428:Cross Infection / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D016469:Fungemia / Q000175:diagnosis* / Q000453:epidemiology*; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult