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Abstract
Background
Fungemia has increased over the past decade and is an important cause of significant morbidity and mortality. Since 1980, there has been an increase in the worldwide studies of nosocomial bloodstream fungal infections. We analyzed the distribution and the clinical characteristics of fungemia at a tertiary care hospital, Kyung Hee University hospital.
Methods
We retrospectively reviewed medical records and laboratory findings of 139 patients who had fungemia from January 2000 to December 2006. We investigated the incidence of each fungal species, yearly occurrence, underlying diseases, hospitalized units, predisposing factors, use of the antifungal agents, mortality, and the characteristics of the expired group.
Results
The most common species isolated was C. albicans (40.3%), followed by C. tropicalis (24.5%). Overall, fungemia occurrence showed an increasing trend during the study period, except for the year 2004. Common predisposing factors were previous antimicrobial therapy (89.2%), central venous catheter (78.4%), and ICU admission state at diagnosis (59.7%). among the 139 patients, 98 (70.5%) were treated. Primary choice of antifungal agents included fluconazole (70.4%) and amphotericin B (29.0%). Overall mortality was 38.9% with the highest rate (47.1%) in patients with C. tropicalis and the lowest one (22.2%) in patients with C. parapsilosis. Predisposing factors for mortality due to fungemia in the univariate analysis included only mechanical ventilation (P=0.008).
References
1. Beck-Sagué C and Jarvis WR. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980–1990: National Nosocomial Infections Surveillance System. J Infect Dis. 1993; 167:1247–51.
2. Zaoutis TE, Argon J, Chu J, Berlin JA, Walsh TJ, Feudtner C. The epidemiology and attributable outcomes of candidemia in adults and children hospitalized in the United States: a propensity analysis. Clin Infect Dis. 2005; 41:1232–9.
3. Richardson MD. Changing patterns and trends in systemic fungal infections. J Antimicrob Chemother. 2005; 56:i5–i11.
4. Marchetti O, Bille J, Fluckiger U, Eggimann P, Ruef C, Garbino J, et al. Epidemiology of candidemia in Swiss tertiary care hospitals: secular trends, 1991–2000. Clin Infect Dis. 2004; 38:311–20.
5. Blumberg HM, Jarvis WR, Soucie JM, Edwards JE, Patterson JE, Pfaller MA, et al. Risk factors for candidal bloodstream infections in surgical intensive care unit patients: The NEMIS prospective multicenter study. Clin Infect Dis. 2001; 33:177–86.
6. Asmundsdottir LR, Erlendsdottir H, Gottfredsson M. Increasing incidence of candidemia: Results from a 20-year nationwide study in Iceland. J Clin Microbiol. 2002; 40:3489–92.
7. Tortorano AM, Peman J, Bernhardt H, Klingspor L, Kibbler CC, Faure O, et al. Epidemiology of candidaemia in Europe: results of 28-month European Confederation of Medical Mycology (ECMM) hospital-based surveillance study. Eur J Clin Microbiol Infect Dis. 2004; 23:317–22.
8. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Michael B. Nosocomial Bloodstream Infections in US Hospitals: Analysis of 24,179 Cases from a Prospective Nationwide Surveillance Study. Clin Infect Dis. 2004; 39:309–17.
9. Korean Nosocomial Infections Surveillance System (KONIS). KONIS official report. http://www.kosnic.org/bbs/zboard.php?id=konisop/[Onine. ] (last visited on 16 October 2007).
10. Colombo AL, Nucci M, Park BJ, Noue´r SA, Arthington-Skaggs B, Matta DA, et al. Epidemiology of Candidemia in Brazil: a Nationwide Sentinel Surveillance of Candidemia in Eleven Medical Centers. J Clin Microbiol. 2006; 44:2816–23.
11. Oho BJ, Choi HY, Lee JS, Cho D, Kee SJ, Shin MG, et al. Clinical and Laboratory Features of Candidemia Caused by Different Candida Species. Korean J Lab Med. 2005; 25:317–23.
12. Byun HW, Kim CH, Kim JK, Eom KS, Park YB, Jang SH, et al. A 5-year review of clinical characteristics and mortality of burn patients with candidemia in a tertiary burn center. Korean J Med. 2006; 70:298–308.
13. Kang BK, Lee HJ, Suh JT. The Trends of the Species and Antimicrobial Susceptibility of Bacteria and Fungi Isolated from Blood Cultures (1986–1996) Korean J Clin Pathol. 1998; 18:57–64.
14. Hsueh PR, Teng LJ, Yang PC, Ho SW, Luh KT. Emergence of nosocomial candidemia at a teaching hospital in Taiwan from 1981 to 2000: increased susceptibility of Candida species to fluconazole. Microb Drug Resist. 2002; 8:311–9.
15. Cheng YR, Lin LC, Young TG, Liu CE, Chen CH, Tsay RW. Risk factors for candidemia-related mortality at a medical center in central Taiwan. J Microbiol Immunol Infec. 2006; 39:155–61.
16. Viudes A, Pemán J, Cantón E, Úbeda P, López-Ribot JL, Gobernado M. Candidemia at a Tertiary-Care Hospital: Epidemiology, Treatment, Clinical Outcome and Risk Factors for Death. Eur J Clin Microbiol Infect Dis. 2002; 21:767–74.
17. Yamamura DLR, Rotstein C, Nicolle LE. Candidemia at selected Canadian sites: results from the Fungal Disease Registry, 1992–1994. CMAJ. 1999; 160:493–9.
18. Takakura S, Fujihara N, Saito T, Kudo T, Iinuma Y, Ichiyama , et al. National surveillance of species distribution in blood isolates of Candida species in Japan and their susceptibility to six antifungal agents including voriconazole and micafungin. J Antimicrob Chemother. 2004; 53:283–9.
19. Trick WE, Fridkin SK, Edwards JR, Hajjeh RA, Gaynes RP. National Nosocomial Infections Surveillance System Hospitals Clinical Infectious Diseases. Secular Trend of Hospital-Acquired Candidemia among Intensive Care Unit Patients in the United States during 1989–1999. Clin Inf Dis. 2002; 35:627–30.
20. Metwally L, Walker MJ, Coyle PV, Hay RJ, Hedderwick S, McCloskey BV, et al. Trends in candidemia and antifungal susceptibility in a university hospital in Northern Ireland 2001–2006. J Infect. 2007; 55:174–8.
21. Lagrou K, Verhaegen J, Peetermans WE, De Rijdt T, Maertens J, Wijngaerden EV. Fungemia at a tertiary care hospital: incidence, therapy, and distribution and antifungal susceptibility of causative species. Eur J Clin Microbiol Infect Dis. 2007; 26:541–7.
22. Sandven P, Bevanger L, Digranes A, Gaustad P, Haukland HH, Steinbakk M. Constant low rate of fungemia in Norway, 1991 to 1996. J Clin Microbiol. 1998; 36:3455–9.
23. Snydman DR. Shifting Patterns in the Epidemiology of Nosocomial Candida Infections. Chest. 2003; 123:500S–3S.
24. Warnock DW. Trends in the epidemiology of invasive fungal infections. Jpn J Med Mycol. 2007; 48:1–12.
25. Clark TA, Slavinski SA, Morgan J, Lott T, Arthington-Skaggs BA, Brandt ME, et al. Epidemiologic and molecular characterization of an outbreak of Candida parapsilosis bloodstream infections in a community hospital. J Clin Microbiol. 2004; 42:4468–72.
26. Komshian SV, Uwaydah AK, Sobel JD, Crane LR. Fungemia caused by Candida species and Torulopsis glabrata in the hospitalized patient: frequency, characteristics, and evaluation of factors influencing outcome. Rev Infect Dis. 1989; 11:379–90.
27. Almirante B, Rodriguez D, Cuenca-Estrella M, Almela M, Sanchez F, Ayats J, et al. Epidemiology, Risk Factors, and Prognosis of Candida parapsilosis Bloodstream Infections: Case-Control Population-Based Surveillance Study of Patients in Barcelona, Spain, from 2002 to 2003. J Clin Microbiol. 2006; 44:1681–5.
28. Shin JH, Kim MN, Shin DH, Jung SI, Kim KJ, Cho D, et al. Genetic relatedness among Candida tropicalis isolates from sporadic cases of fungemia in two university hospitals in Korea. Infect Control Hosp Epidemiol. 2004; 25:634–40.
Table 1.
Clinical characteristics of 139 patients with fungemia
Table 2.
Fungus species isolated from blood cultures from 2000 to 2006
Table 3.
Distribution of the fungemia according to hospitalization unit
Table 4.
Therapeutic regimens for patients with fungemia
Table 5.
Univariate analyses of risk factors of fungemia-associated mortality in 129 patients
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