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Nosocomial fungemia in a large community teaching hospital
1Northeastern Ohio Universities College of Medicine, Rootstown.
Abstract:
This report reviews 48 episodes of hospital-acquired fungemia that occurred over a four-year period at a large community teaching hospital. The incidence of hospital-acquired fungemia increased eightfold during the study period. Candida albicans (58%), Candida tropicalis (25%), and Candida parapsilosis (15%) were the most common fungal pathogens isolated from blood cultures. Twenty-one patients (44%) had concomitant bacteremia. Intravascular catheters (100%), antibiotic administration (98%), urinary catheters (81%), surgical procedures (65%), parenteral alimentation (60%), and corticosteroid administration (54%) were the most common predisposing factors. The overall mortality rate was 75%. Hospitalization on the medical service, age greater than 60 years, and hospital stay less than 100 days were associated with a significantly increased mortality rate.
Insights
Hospital-acquired fungemia cases rose significantly over four years. Common causes include Candida species and risk factors like catheters, with a high 75% mortality rate.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Mycology
Background:
- Hospital-acquired fungemia presents a growing challenge in healthcare settings.
- Fungal bloodstream infections (fungemia) are associated with significant morbidity and mortality.
- Understanding trends and risk factors is crucial for effective prevention and treatment.
Purpose of the Study:
- To review hospital-acquired fungemia episodes over a four-year period.
- To identify common fungal pathogens and predisposing factors.
- To determine the mortality rate and associated risk factors for increased mortality.
Main Methods:
- Retrospective review of 48 hospital-acquired fungemia cases.
- Analysis of fungal pathogens, predisposing factors, and patient demographics.
- Statistical analysis to identify factors associated with increased mortality.
Main Results:
- Incidence of hospital-acquired fungemia increased eightfold.
- Candida albicans (58%), Candida tropicalis (25%), and Candida parapsilosis (15%) were most common.
- Predisposing factors included intravascular catheters (100%), antibiotics (98%), and urinary catheters (81%).
- Overall mortality rate was 75%.
- Increased mortality was linked to medical service hospitalization, age >60, and shorter hospital stays.
Conclusions:
- Hospital-acquired fungemia incidence is rising, demanding attention.
- Aggressive management of risk factors like invasive devices and antibiotic use is critical.
- High mortality necessitates improved diagnostic and therapeutic strategies for fungemia.