Related Experiment Videos
Epidemiology, diagnosis, and therapy of fungal infections in surgery
1Athens University School of Medicine, First Department of Propedeutic Medicine, Laiko General Hospital, Greece.
Abstract:
Over the past decade, the incidence of hospital-acquired bloodstream infections caused by Candida strains has risen, while the implicated species have changed. Candida tropicalis, Candida parapsilosis, and Candida glabrata all have increased in incidence. Data from the Centers for Disease Control and Prevention reveal that, between 1980 and 1990, Candida emerged as the sixth most common nosocomial pathogen (7.2%) and was the fourth most common pathogen in nosocomial bloodstream infections, surpassed only by coagulase-negative staphylococci, Staphylococcus aureus, and enterococci. The incidence of candidemia is dramatically higher in high-risk critical-care units: 25% of cases occur in surgical intensive-care units (ICUs) versus 25% in bone marrow transplantation units, 20% in medical ICUs, 20% in general medical wards, and 10% in oncology-hematology units. Burns and gastrointestinal surgery predispose to nosocomial candidemia. Independent risk factors include prior therapy with multiple antibiotics, isolation of Candida from sites other than blood, and prior hemodialysis. Crude mortality exceeds 55% and is associated with older age and concomitant renal failure, hepatic failure, acute respiratory diseases, or postoperative shock. In addition to extreme vigilance for early recognition of Candida sepsis in critically ill surgical patients, the high risk for candidemia probably necessitates fungal surveillance cultures and initiation of preemptive antifungal therapy in high-risk surgical patients.
Insights
Hospital-acquired Candida bloodstream infections are increasing, particularly in intensive care units. Early recognition and preemptive antifungal therapy are crucial for high-risk surgical patients.
Area of Science:
- Infectious Diseases
- Mycology
- Critical Care Medicine
Background:
- Hospital-acquired bloodstream infections (HAIs) caused by Candida species have increased over the last decade.
- Specific Candida species like C. tropicalis, C. parapsilosis, and C. glabrata show rising incidence.
- Candida is now a leading cause of nosocomial infections, particularly in intensive care units (ICUs).
Purpose of the Study:
- To analyze the changing incidence and risk factors of hospital-acquired candidemia.
- To identify patient populations at highest risk for developing candidemia.
- To inform strategies for early recognition and management of invasive candidiasis.
Main Methods:
- Retrospective analysis of epidemiological data on nosocomial pathogens.
- Review of incidence rates of Candida bloodstream infections from 1980-1990.
- Identification of independent risk factors and high-risk clinical settings.
Main Results:
- Candida emerged as the sixth most common nosocomial pathogen (7.2%) and fourth in bloodstream infections.
- Candidemia incidence is highest in surgical ICUs (25%), bone marrow transplant units (25%), and medical ICUs (20%).
- Independent risk factors include prior broad-spectrum antibiotics, non-blood Candida isolates, and hemodialysis; crude mortality exceeds 55%.
Conclusions:
- High-risk surgical patients require vigilant monitoring for Candida sepsis.
- Fungal surveillance cultures and preemptive antifungal therapy may be necessary for high-risk surgical patients.
- The changing epidemiology of Candida necessitates updated infection control and treatment strategies.