Increasing fungal infections in cardiovascular ICUs

Introduction

In past years there has been an increase in the occurrence of systemic fungal infections in ICUs. Although Candida species are the leading cause of hospital fungal infections, severely ill patients can develop invasive infection by emerging fungus or by innocuous inhabitants of the environment.

Objective

To describe the occurrence of bloodstream and urinary tract infections in ICUs of a cardiology hospital.

Methods

We analyzed all cases of bloodstream and urinary tract fungal infections that occurred in two clinical ICUs at the Heart Institute of São Paulo University School of Medicine from January 2000 to November 2005.

Results

Among 376 bloodstream infections, 26 (6.9%) were caused by Candida species and one by Trichosporon spp. Seventy-three percent of candidaemia occurred in the last 2 years of study. The mean age was 61.6 years and the mean ICU length of stay before the diagnosis was 35 days. The following Candida species were identified: C. albicans = 42%, C. parapsilosis = 23%, C. tropicalis = 19%, C. glabrata = 11% and C. guillermondi = 4%. Among 585 urinary tract infections episodes, 253 (43%) were caused by fungi: 47% by C. albicans, 34% by non-albicans Candida species and 18% by Trichosporon spp.

Conclusion

We observed an increasing incidence of bloodstream fungal infections caused by non-albicans Candida species, predominantly in the last 2 years in severely ill long-staying inhospital cardiac patients. Trichosporon spp. is a fungus once thought to cause only superficial infections, but has been increasingly identified as an opportunistic systemic pathogen in severely immunodepressed patients. The occurrence of bloodstream infection and the high incidence of urinary tract infection caused by Trichosporon spp. in this study led us to begin a prospective study to identify risk factors and treatment strategies.