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[Clinical aspects and prognosis of candidemia, a 6-year retrospective study]
T Bregenzer1, A C Evison-Eckstein, R Frei
1Abteilung für Infektiologie, Kantonsspital Basel.
Abstract:
In recent decades an increase in the incidence of fungal infection has been reported. We retrospectively analyzed 41 patients with candidemia seen at Basel University Hospital over a six-year period. 1.2-6.7 candidemias per 10000 admissions were observed. In contrast to other studies, there was no increase during the study period. Out of 41 patients, 19 were hospitalized in ICUs. All patients had risk factors such as intravascular catheters (92.7%), antibiotic therapy (88%), immunosuppressive therapy (31%), indwelling Foley catheters (54%) and previous surgery (63%). The most frequent symptoms were fever with rigor, tachycardia and hypotension. The isolates were Candida albicans (n = 28), Torulopsis glabrata (n = 5), C. krusei (n = 3), C. parapsilosis (n = 2), C. guilliermondii, C. kefyr and C. lusitaniae (n = 1 each). In 22 patients, candida colonization had been documented and 5 patients had superficial mucocutaneous candidiasis before candidemia. The initial foci were the gastrointestinal tract (n = 13), an intravascular catheter (n = 8), the urinary tract (n = 5), the respiratory tract, or intravenous drug use (n = 3 each). Out of 32 patients who were treated either with amphotericin B or fluconazole, 13 died. 5 of the untreated patients died, in 3 instances before microbiological diagnosis. The mortality was similar for treatment with amphotericin B and with fluconazole (50% vs. 33%) (p = 0.3).
Insights
This study found no increase in candidemia (fungal blood infection) incidence over six years. Risk factors like catheters and antibiotic use were common, and mortality was similar between amphotericin B and fluconazole treatments.
Area of Science:
- Infectious Diseases
- Mycology
- Hospital Epidemiology
Background:
- Fungal infections, particularly candidemia, have seen increased incidence globally.
- Understanding local epidemiology is crucial for effective management.
Purpose of the Study:
- To retrospectively analyze the incidence, risk factors, clinical presentation, and outcomes of candidemia at a university hospital.
- To assess trends in candidemia incidence over a six-year period.
Main Methods:
- Retrospective analysis of 41 patients diagnosed with candidemia over a six-year period.
- Data collection included patient demographics, risk factors, clinical symptoms, causative Candida species, and treatment outcomes.
- Incidence rates were calculated per 10,000 admissions.
Main Results:
- Observed incidence of 1.2-6.7 candidemias per 10,000 admissions, with no significant increase over the study period.
- Common risk factors included intravascular catheters (92.7%), antibiotic therapy (88%), and indwelling Foley catheters (54%).
- Candida albicans was the most frequent isolate (n=28). Mortality was 50% for amphotericin B and 33% for fluconazole treated patients, with no statistically significant difference.
Conclusions:
- Despite common risk factors, candidemia incidence remained stable at this institution.
- Treatment outcomes with amphotericin B and fluconazole showed similar mortality rates.
- Further research into optimizing antifungal therapy and prevention strategies is warranted.