Health care-associated candidemia--a distinct entity?

The concept of health care-associated infection (HCAI) was developed to address the fact that select patients now present to the hospital with infections due to traditionally nosocomial pathogens. Although epidemiologic studies document the clear existence of health care-associated pneumonia, little is known about fungal pathogens and their role in HCAIs.

To describe the epidemiology of health care-associated bloodstream infections (BSIs) due to candida species and to compare patients with HCA candidemia to nosocomial candidemia.

Retrospective case series.

Academic, tertiary care hospital.

We measured the proportion of cases of candidal BSI classified as health care-associated along with the microbiology of these infections. We compared health care-associated and nosocomial cases of candidemia with respect to demographics, severity of illness, and fluconazole susceptibility.

We noted 233 cases of candidal BSI over a 3-year period. Nearly one-quarter represented an HCAI that presented to the hospital, as opposed to a nosocomial process. Although patients with HCA candidemia were similar to subjects with nosocomial infection in terms of underlying comorbidities and severity of illness, those with HCA yeast BSI were more likely to be immunosuppressed and to have their infection caused by a fluconazole-resistant organism. C. glabrata was seen more often in patients presenting to the hospital with an HCA case of candidemia.

Clinicians must recognize the potential for candida species to cause HCA infections and to be present at time of hospital presentation. Physicians need to consider this and the distribution of species of yeast causing BSI in their institution when considering initial therapy for patients with a suspected BSI.