title: Nosocomial candidemia; risk factors and prognosis revisited; 11 years experience from a Norwegian secondary hospital.
abstract: The aim of the study was to review the epidemiology and prognosis of candidemia in a secondary hospital, and to examine the intra-hospital distribution of candidemia patients. Study design is a retrospective cohort study. Trough 2002-2012, 110 cases of candidemia were diagnosed, giving an incidence of 2, 6/100,000 citizens/year. Overall prognosis of candidemia was dismal, with a 30 days case fatality rate of 49% and one year case fatality rate of 64%. Candidemia was a terminal event in 55% of 30 days non-survivors, defined as Candida blood cultures reported positive on the day of death or thereafter (39%), or treatment refrained due to hopeless short-term prognosis (16%). In terminal event candidemias, advanced or incurable cancer was present in 29%. Non-survivors at 30 days were 9 years (median) older than survivors. In 30 days survivors, candidemia was not recognised before discharge in 13% of cases. No treatment were given and no deaths or complications were observed in this group. Candidemia patients were grouped into 8 patient categories: Abdominal surgery (35%), urology (13%), other surgery (11%), pneumonia (13%), haematological malignancy (7%), intravenous drug abuse (4%), other medical (15%), and new-borns (3%). Candidemia was diagnosed while admitted in the ICU in 46% of patients. Urology related cases were all diagnosed in the general ward. Multiple surgical procedures were done in 60% of abdominal surgery patients. Antibiotics were administered prior to candidemia in 87% of patients, with median duration 17 (1-108) days. Neutropenia was less common than expected in patients with candidemia (8/105) and closely associated to haematological malignancy (6/8). Compared with previous national figures the epidemiology of invasive candidiasis seems not to have changed over the last decade.
authors: Department of Infectious Diseases, Akershus University Hospital, Nordbyhagen, Norway.
authors: Jan-Erik
authors: JE
authors: Berdal
authors: Department of Anaesthesiology, Akershus University Hospital, Nordbyhagen, Norway.
authors: Rolf
authors: R
authors: Haagensen
authors: Department of Microbiology, Akershus University Hospital, Nordbyhagen, Norway.
authors: Trond
authors: T
authors: Ranheim
authors: Department of Infectious Disease Epidemiology Norwegian Institute of Public Health, Oslo, Norway.
authors: Jørgen V
authors: JV
authors: Bjørnholt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058387:Candidemia / Q000401:mortality*; D003428:Cross Infection / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D063728:Secondary Care Centers; D055815:Young Adult