Frequency, mortality and risk factors of candidemia at a tertiary care hospital

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Introduction

The incidence of fungal infections has been increasing for the last three decadess, especially in neutropenic, cancer and critically ill patients. It is associated with high mortality rates.

Methods

We retrospectively reviewed medical charts of adult patients with fungemia from 1989 to 1998 at the University Hospital of Geneva. For patients with candidemia, demographic information, risk factors (antibiotic treatment, preceding surgery, cancer, intravascular devices, ICU stay), outcome, and the incidence of fungal species was analyzed as well as the overall consumption of fluconazole.

Results

Of 291 patients with fungemia, we reviewed 278 (96%) medical records, 184 (66%) were from male patients. The mean age was 60 years and the overall mortality 45.5%. Candida albicans (61%) was the most commonly identified species followed by C. glabrata (15%), and C. parapsilosis (6%). The incidence of candidemia ranged from 0.2 to 0.56 per 10 000 patient-days with the highest incidence in 1993 and the lowest in 1997. Of the risk factors analyzed only ICU stay was statistically significant (P<0.0001) (OR 3.42; CI 1.98–5.92). When candidemia was revealed, 38% of the patients were hospitalized in an ICU. Most candidemias occurred several days after admission, that is 52% after two weeks and 70% after three weeks.

Conclusion

The regular use of fluconazole since 1990 may explain a decreasing trend of candidemias due to C. albicans, whereas those due to other Candida spp remained stable. The predisposing risk factors analyzed associated with a high mortality were similar to those described in other series. For the last two years, fungemia remained low and stable in our institution. No significant changes in the incidence of fungal species during the 10 year study period were observed.