Non-albicans Candida spp. causing fungaemia: pathogenicity and antifungal resistance.

Nosocomial fungaemia: a 2-year prospective study.

OBJECTIVE To examine the incidence, epidemiology, and clinical characteristics of candidemia in a pediatric intensive care unit. DESIGN Retrospective cohort study. SETTING Pediatric intensive care unit of a tertiary care teaching and referral hospital in north India. SUBJECTS All patients with candidemia from March 1993 to December 1996. INTERVENTIONS Patient-related data were analyzed to study candidemia in relation to reason for fungal culture, underlying medical conditions, predisposing factors, Candida isolates, antimicrobial and antifungal treatment, and deaths. MEASUREMENTS AND MAIN RESULTS Sixty-four patients with candidemia were identified. The Candida species isolated were Candida tropicalis (48.4%), C. albicans (29.7%), C. guillermondii (14.1%), C. krusei (6.3%), and C. glabrata (1.6%). Thirty-three patients were detected by a high-risk surveillance blood culture, whereas 31 patients were detected while undergoing septic workup. Sixteen (25%) patients were asymptomatic; they recovered without any antifungal therapy and without any sequelae. Of 48 symptomatic patients, 11 died before institution of antifungal therapy; 37 received oral itraconazole (10 mg.kg(-1).day(-1)). Seven (19%) of these 37 patients died. Those who recovered had sterile culture on average by day 14 (range, 4-30) and received the antifungal therapy on average for 24 days (range, 9-42 days). Overall mortality rate was 28.1%, and bivariate analysis showed significant association with Pediatric Risk of Mortality score (p =.0001), presence of symptoms (p =.003), isolation of nonalbicans Candida in general (p =.04) and C. tropicalis specifically (p =.001), and failure to give presumptive antifungal therapy (p =.055). On multivariate analysis, Pediatric Risk of Mortality score and isolation of C. tropicalis were the only significant predictors of mortality. CONCLUSIONS Nonalbicans Candida accounted for 70% of candidemia in a pediatric intensive care unit. High-risk surveillance blood cultures aided diagnosis in about half the patients. Severity of illness and isolation of C. tropicalis were significant predictors of mortality.

Candidemia in a pediatric intensive care unit.

Summary

In a retrospective analysis of 128 cases of Candida bloodstream infections in a London teaching hospital between 1995 and 2001, the incidence of candidaemia increased from 0.2/1000 admissions in 1995 to 0.5 and 0.4/1000 admissions in 2000 and 2001, respectively. Risk factors for candidaemia included the presence of intravascular (IV) lines (88%), admission to intensive care (51%), parenteral nutrition (35%), multiple antibiotics (74%), corticosteroid therapy (12%), cancer chemotherapy (11%), renal transplantation (5%) and neutropenia (3%). The sources of infection were IV lines (77%), the urinary tract (7%) and the gastrointestinal tract (7%). Serious infective complications (endocarditis, endophthalmitis or brain abscess) were noted in 6% of cases. The most frequently isolated species were Candida albicans (64%), C. glabrata (20%), C. tropicalis (9%) and C. parapsilosis (5%). The overall fluconazole-resistance rate of Candida spp. was 7% (MIC ≥ 64 mg l−1). All the C. albicans isolates were sensitive to fluconazole (MIC ≤ 8 mg l−1) whereas 20% of non-C. albicans isolates (27% of C. glabrata and 14%C. tropicalis) were resistant. The mortality rate (35%) was lower than in other reports and may be due to the early recognition of candidaemia and the prompt removal of IV lines together with the initiation of appropriate antifungal therapy. Regular surveillance of local Candida species, resistance profiles and risk factors is important in order to identify patients at risk and to develop empirical treatment protocols to reduce the incidence and mortality of candidaemia.

Zusammenfassung

Eine retrospektive Analyse von 128 Blutstrominfektionen in einem Londoner Lehrkrankenhaus in der Zeit von 1995 bis 2001 ergab einen Anstieg von 0.2/1000 Einweisungen 1995 auf 0.5 und 0.4/1000 Einweisungen 2000 und 2001. Candidamie-Risikofaktoren waren intravasale Zugange (88%), Intensivpflege (51%), parenterale Ernahrung (35%), multiple Antibiotika (74%), Corticoid-Therapie (12%), Krebs-Chemotherapie (11%), Nierentransplantation (5%) und Neutropenie (3%). Infektionsquellen waren intravasale Zugange (77%), Harnwege (7%) und Gastrointestinaltrakt (7%). Schwere Infektionskomplikationen (Endokarditis, Endophthalmitis und Gehirnabszesse) traten in 6% auf. Die am haufigsten isolierten Species waren Candida albicans (64%), C. glabrata (20%), C. tropicalis (9%) und C. parapsilosis (5%). Die Fluconazolresistenzrate fur Candida spp. insgesamt lag bei 7% (MIC ≥ 64 mg ml−1). Samtliche C. albicans-Isolate waren empfindlich fur Fluconazol (MIC ≥ 8 mg ml−1), wahrend 20% der Nicht-albicans-Isolate resistent waren (27% von C. glabrata und 14% von C. tropicalis. Die Mortalitat lag mit 35% niedriger als in anderen Berichten, was an der fruhen Erkennung der Candidamie und der konsequenten Beseitigung intravasaler Zugangen gleichzeitig mit dem Beginn einer angemessenen antimykotischen Therapie liegen mag. Regelmasige Uberwachung der lokalen Candida-Species, der Resistenzprofile und Risikofaktoren sind unverzichtbar, um die Risikopatienten zu erkennen und empirische Behandlungsprotokolle zu erstellen, damit die Candidamie-Inzidenz und -Mortalitat gesekt werden konnen.

Candidaemia in a London teaching hospital: analysis of 128 cases over a 7-year period.

Candida tropicalis fungaemia in adult patients with haematological malignancies : clinical features and risk factors

Hospital-acquired candidaemia: experience from a developing country.

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Hospital-acquired candidaemia: experience from a developing country.