title: Secular trends of candidemia in a tertiary care hospital.
abstract: BACKGROUND
  Candidemias account for 8% to 15% of hospital-acquired bloodstream infections. They have been associated with previous exposure to antimicrobials and are considered high-morbidity infections with high treatment costs. This study characterizes candidemias in a tertiary care hospital and assesses their incidence rates, clinical and microbiological features, and use of antifungals.
  
  
  METHODS
  We assessed hospital-acquired candidemias in the period from January 1997 to July 2007 in a high-complexity private hospital.
  
  
  RESULTS
  There were 151 cases of candidemia in 147 patients. The incidence rate was 0.74 episodes/1000 admissions. The mean age of the patients was 60 years (standard deviation +/- 24.9), and the mean length of hospital stay before the blood culture identified candidemia was 40.9 days (standard deviation +/- 86.3). The in-hospital mortality rate was 44.2%. C albicans was isolated in 44% (n = 67) of the cases, and no difference in mortality rates was found between species (Candida albicans vs C non-albicans, P = .6). The average use of antifungals in the period was 104.0 defined daily dose/1000 patient-days.
  
  
  CONCLUSIONS
  We found a high mortality rate associated to candidemia events and an increasingly important role of Candida non-albicans. New approaches to health care-related infection control and to defining prophylactic and preemptive therapies should change this scenario in the future.
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, Brazil. zinsly@terra.com.br
authors.forename: Thiago Zinsly
authors.initials: TZ
authors.lastname: Sampaio Camargo
authors.forename: Alexandre Rodrigues
authors.initials: AR
authors.lastname: Marra
authors.forename: Claudia Vallone
authors.initials: CV
authors.lastname: Silva
authors.forename: Maria Fatima Santos
authors.initials: MF
authors.lastname: Cardoso
authors.forename: Marinês Dalla Valle
authors.initials: MD
authors.lastname: Martino
authors.forename: Luis Fernando Aranha
authors.initials: LF
authors.lastname: Camargo
authors.forename: Luci
authors.initials: L
authors.lastname: Correa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000145:classification / Q000302:isolation & purification*; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D005260:Female; D016469:Fungemia / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D006761:Hospitals; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D000935:Antifungal Agents