Nosocomial fungemias in a general hospital. Epidemiology and prognostic factors. Prospective study 1993-1998
Gómez, J.; Baños, V.; Simarro, E.; Ruiz, J.; Requena, L.; Pérez, J.; Canteras, M.; Valdés, M.
Enfermedades Infecciosas Y Microbiologia Clinica 19(7): 304-307
2001
ISSN/ISBN: 0213-005X PMID: 11747788 Document Number: 540123
Nosocomial fungaemias are infections with a high mortality rate. In recent years their incidence has increased, probably because of the growing population of immunocompromised patients who undergo aggressive diagnostic and therapeutic techniques. This study investigated the epidemiological characteristics, risk factors, clinical features and prognosis of fungaemia. All the patients with proven fungaemia in the authors' centre in Spain were prospectively evaluated during a 5 year-period. After finishing antifungal treatment a minimum follow-up of one month was carried out. Fungal isolation and identification were performed by standard tests. During the period of study there were 81 patients with an episode of nosocomial fungaemia, a rate of 0.9 episodes per thousand patients admitted. Candida albicans was the most frequently isolated species (n=53), followed by C. parapsilosis (n=11), C. tropicalis (n=6) and C. glabrata [Torulopsis glabrata] (n=5). Most of the patients had a central intravenous line and were on parenteral nutrition therapy. All of them had previously received at least one course of broad-spectrum antibiotics. Overall mortality was 49.6%. Poor prognosis was significantly associated with: age over 65 years, surgery, leukocytosis, shock, and delay in antifungal treatment. It is concluded that the incidence of fungaemia is high in this environment. It is associated with a high mortality rate, especially in patients in whom the beginning of antifungal treatment was delayed. A higher clinical index of suspicion might improve the poor outcome in these patients.