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Secular Trends of Candidemia in a Large Tertiary-Care Hospital From 1988 to 2000: Emergence of Candida parapsilosis

Published online by Cambridge University Press:  21 June 2016

Lucía García San Miguel*
Affiliation:
Infectious Diseases Department, Ramón y Cajal HospitalMadrid, Spain
Javier Cobo
Affiliation:
Infectious Diseases Department, Ramón y Cajal HospitalMadrid, Spain
Enrique Otheo
Affiliation:
Pediatric Intensive Care Unit, Ramón y Cajal Hospital, Madrid, Spain
Aurora Sánchez-Sousa
Affiliation:
Microbiology Department, Ramón y Cajal HospitalMadrid, Spain
Victor Abraira
Affiliation:
Biostatistics Unit, Ramón y Cajal Hospital, Madrid, Spain
Santiago Moreno
Affiliation:
Infectious Diseases Department, Ramón y Cajal HospitalMadrid, Spain
*
Hospital Ramón y Cajal, Servicio de Enfermedades Infecciosas, Cta de Colmenar Km 9, 100, Madrid 28034, Spainlgarcias.hrc@salud.madrid.org

Abstract

Objective:

To analyze the secular trends of candidemia in a large tertiary-care hospital to determine the overall incidence, as well as the incidence by ward and by species, and to detect the occurrence of outbreaks.

Design:

Retrospective descriptive analysis. Secular trends were calculated using the Mantel-Haenszel test.

Setting:

A large tertiary-care referral center in Spain with a pediatric intensive care unit (ICU) to which more than 500 children with congenital cardiac disease are admitted annually.

Patients:

All patients with candidemia occurring from 1988 to 2000 were included. Cases were identified from laboratory records of blood cultures.

Results:

There were 331 episodes of candidemia. The overall incidence of nosocomial candidemia was 0.6 episode per 1,000 admissions and remained stable throughout the study period (P = .925). The species most frequently isolated was Candida albicans, but the incidence of C. parapsilosis candidemia increased (P = .035). In the pediatric ICU, the incidence of C. parapsilosis was 5.6 episodes per 1,000 admissions and it was the predominant species. Outbreaks occurred occasionally in the pediatric ICU, suggesting nosocomial transmission.

Conclusions:

During this 13-year period, the incidence of candidemia remained stable in this hospital, but C. parapsilosis increased in frequency. Occasional outbreaks of candidemia suggested nosocomial transmission of Candida species (Infect Control Hosp Epidemiol 2005;26:548-552).

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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References

1.Henderson, VJ, Hirvela, ER. Emerging and reemerging microbial threats: nosocomial fungal infections. Arch Surg 1996;3:330337.Google Scholar
2.Emori, TG, Gaynes, RP. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev 1993;6:428442.CrossRefGoogle ScholarPubMed
3.Harvey, RL, Myers, JP. Nosocomial fungemia in a large community teaching hospital. Arch Intern Med 1987;147:21172120.CrossRefGoogle Scholar
4.Beck Sague, C, Jarvis, WR. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980-1990: National Nosocomial Infections Surveillance System. J Infect Dis 1993;167:12471251.Google Scholar
5.Jarvis, WR. Epidemiology of nosocomial fungal infections, with emphasis on Candida species. Clin Infect Dis 1995;20:15261530.Google Scholar
6.Pittet, D, Wenzel, RRNosocomial bloodstream infections: secular trends in rates, mortality, and contribution to total hospital deaths. Arch Intern Med 1995;155:11771184.Google Scholar
7.Banerjee, SN, Emori, TG, Culver, DH, et al.Secular trends in nosocomial primary bloodstream infections in the United States, 1980-81. Am J Med 1991;9(suppl 3B):3S87S.Google Scholar
8.Pfaller, MA, Jones, RN, Messer, SA, Edmond, MB, Wenzel, RP. National surveillance of nosocomial blood stream infection due to Candida albicans: frequency of occurrence and antifungal susceptibility in the SCOPE Program. Diagn Microbiol Infect Dis 1998;31:327332.CrossRefGoogle ScholarPubMed
9.Poikonen, E, Lyytikainen, O, Anttila, VJ, Ruutu, P. Candidemia in Finland, 1995-1999. Emerg Infect Dis 2003;9:985990.CrossRefGoogle ScholarPubMed
10.Hsueh, PR, Teng, LJ, Yang, PC, Ho, SW, Luh, KT. Emergence of nosocomial candidemia at a teaching hospital in Taiwan from 1981 to 2000: increased susceptibility of Candida species to fluconazole. Microb Drug Resist 2002;8:311319.Google Scholar
11.Horn, R, Wong, B, Kiehn, TE, Armstrong, D. Fungemia in a cancer hospital: changing frequency, earlier onset, and results of therapy. Rev Infect Dis 1985;7:646655.CrossRefGoogle Scholar
12.Komshian, SV, Uwaydah, AK, Sobel, JD, Crane, LR. Fungemia caused by Candida species and Torulopsis glabrata in the hospitalized patient: frequency, characteristics, and evaluation of factors influencing outcome. Rev Infect Dis 1989;11:379390.Google Scholar
13.Fraser, VJ, Jones, M, Dunkel, J, Storfer, S, Medoff, G, Dunagan, WC. Candidemia in a tertiary care hospital: epidemiology, risk factors, and predictors of mortality. Clin Infect Dis 1992;15:414421.CrossRefGoogle Scholar
14.Karlowsky, JA, Zhanel, GG, Klym, KA, Hoban, DJ, Kabani, AM. Candidemia in a Canadian tertiary care hospital from 1976 to 1996. Diagn Microbiol Infect Dis 1997;29:59.Google Scholar
15.Voss, A, le Noble, JL, Verduyn Lunel, FM, Foudraine, NA, Meis, JF. Candidemia in intensive care unit patients: risk factors for mortality. Infection 1997;25:811.Google Scholar
16.Wenzel, RP. Nosocomial candidemia: risk factors and attributable mortality. Clin Infect Dis 1995;20:15311534.Google Scholar
17.Kossoff, EH, Buescher, ES, Karlowicz, MG. Candidemia in a neonatal intensive care unit: trends during fifteen years and clinical features of III cases. Pediatr Infect Dis J 1998;17:504508.Google Scholar
18.Baran, J Jr, Muckatira, B, Khatib, R. Candidemia before and during the fluconazole era: prevalence, type of species and approach to treatment in a tertiary care community hospital. Scand J Infect Dis 2001;33:137139.Google Scholar
19.Pfaller, M. Nosocomial candidiasis: emerging species, reservoirs and models of transmission. Clin Infect Dis 1996;2:S89S94.CrossRefGoogle Scholar
20.Wright, WL, Wenzel, RP. Nosocomial Candida: epidemiology, transmission, and prevention. Infect Dis Clin North Am 1997;11:411425.Google Scholar
21.Wingard, JR. Importance of Candida species other than C. albicans as pathogens in oncology patients. Clin Infect Dis 1997;20:115125.CrossRefGoogle Scholar
22.Pfaller, MA, Jones, RN, Messer, SA, Edmond, MB, Wenzel, RP. National surveillance of nosocomial blood stream infection due to species of Candida other than Candida albicans: frequency of occurrence and antifungal susceptibility in the SCOPE Program. Diagn Microbiol Infect Dis 1998;30:121129.Google Scholar
23.Pfaller, MA, Jones, RN, Doern, GV, et al.Bloodstream infections due to Candida species: SENTRY antimicrobial surveillance program in North America and Latin America, 1997-1998. Antimicrob Agents Chemother 2000;44:747751.Google Scholar
24.Pfaller, MA, Jones, RN, Doern, GV, et al.International surveillance of blood stream infections due to Candida species in the European SENTRY Program: species distribution and antifungal susceptibility including the investigational triazole and echinocandin agents. Diagn Microbiol Infect Dis 1999;35:1925.CrossRefGoogle ScholarPubMed
25.Snydman, DR. Shifting patterns in the epidemiology of nosocomial Candida infections. Chest 2003;123:500S503S.Google Scholar
26.Peman, J, Canton, E, Orero, A, Viudes, A, Frasquet, J, Gobernado, M. Epidemiology of candidemia in Spain: multicenter study. Revista Ibero Americana de Micologia 2002;19:3035.Google Scholar
27.Safdar, A, Perlin, DS, Armstrong, D. Hematogenous infections due to Candida parapsilosis: changing trends in fungemic patients at a comprehensive cancer center during the last four decades. Diagn Microbiol Infect Dis 2002;44:1116.CrossRefGoogle Scholar
28.Verduyn Lunel, FM, Meis, JF, Voss, A. Nosocomial fungal infections: candidemia. Diagn Microbiol Infect Dis 1999;34:213220.Google Scholar
29.Marr, KA, Seidel, K, White, TC, Bowden, RA. Candidemia in allogenic blood and marrow transplant recipients: evolution of risk factors after the adoption of prophylactic fluconazole. J Infect Dis 2000;181:309316.Google Scholar
30.Sherertz, RJ, Gledhill, KS, Hampton, KD, et al.Outbreak of Candida bloodstream infections associated with retrograde medication administration in a neonatal intensive care unit. J Pediatr 1992;120:455461.Google Scholar
31.Reagan, DR, Pfaller, MA, Hollis, RJ, Wenzel, RP. Evidence of nosocomial spread of Candida albicans causing bloodstream infection in a neonatal intensive care unit. Diagn Microbiol Infect Dis 1995;21:191194.Google Scholar
32.White, GC, Sisson, PR, Freeman, R, Cookson, BD. Rapid characterization of Candida albicans by pyrolysis mass spectrometry. J Med Microbiol 1994;41:98105.Google Scholar
33.Vazquez, JA, Sanchez, V, Dmuchowski, C, Dembry, L, Jack, D, Zervos, MJ. Nosocomial acquisition of Candida albicans: an epidemiologic study. J Infect Dis 1993;168:195201.Google Scholar
34.Trilla, A. Epidemiology of nosocomial infections in adult intensive care units. Intensive Care Med 1994;20(suppl 3):S1S4.CrossRefGoogle ScholarPubMed
35.Isenberg, HD, Tucci, V, Cintron, F, Singer, C, Weinstein, GS, Tyras, DH. Single-source outbreak of Candida tropicalis complicating coronary bypass surgery. J Clin Microbiol 1989;27:24262428.Google Scholar
36.Moro, ML, Maffei, C, Manso, E, Morace, G, Polonelli, L, Biavasco, F. Nosocomial outbreak of systemic candidosis associated with parenteral nutrition. Infect Control Hosp Epidemiol 1990;11:2735.CrossRefGoogle ScholarPubMed
37.Finkelstein, R, Reinhertz, G, Hashman, N, Merzbach, D. Outbreak of Candida tropicalis fungemia in a neonatal intensive care unit. Infect Control Hosp Epidemiol 1993;14:587590.CrossRefGoogle Scholar
38.Betremieux, RChevrier, S, Quindos, G, Sullivan, D, Polonelli, L, Guiguen, C. Use of DNA fingerprinting and biotyping methods to study a Candida albicans outbreak in a neonatal intensive care unit. Pediatr Infect Dis J 1994;13:899905.CrossRefGoogle Scholar
39.Welbel, SF, McNeil, MM, Kuykendall, RJ, et al.Candida parapsilosis bloodstream infections in neonatal intensive care unit patients: epidemiologic and laboratory confirmation of a common source outbreak. Pediatr Infect Dis J 1996;15:9981002.CrossRefGoogle ScholarPubMed
40.Levin, AS, Costa, SF, Mussi, NS, et al.Candida parapsilosis fungemia associated with implantable and semi-implantable central venous catheters and the hands of healthcare workers. Diagn Microbiol Infect Dis 1998;30:243249.CrossRefGoogle ScholarPubMed
41.Huang, YC, Lin, TY, Peng, HL, Wu, JH, Chang, HY, Leu, HS. Outbreak of Candida albicans fungaemia in a neonatal intensive care unit. Scand J Infect Dis 1998;30:137142.Google Scholar
42.Lupetti, A, Tavanti, A, Davini, P, et al.Horizontal transmission of Candida parapsilosis candidemia in a neonatal intensive care unit. J Clin Microbiol 2002;40:23632369.CrossRefGoogle Scholar
43.Bart Delabesse, E, van Deventer, H, Goessens, W, et al.Contribution of molecular typing methods and antifungal susceptibility testing to the study of a candidemia cluster in a burn care unit. J Clin Microbiol 1995;33:32783283.Google Scholar
44.Noskin, GA, Lee, J, Hacek, DM, et al.Molecular typing for investigating an outbreak of Candida krusei. Diagn Microbiol Infect Dis 1996;26:117123.Google Scholar
45.Vazquez, JA, Boikov, D, Boikov, S, Dajani, AS. Use of electrophoretic karyotyping in the evaluation of Candida infections in a neonatal intensive-care unit. Infect Control Hosp Epidemiol 1997;18:3237.CrossRefGoogle Scholar
46.Diekema, DJ, Messer, SA, Hollis, RJ, Wenzel, RP, Pfaller, MA. An outbreak of Candida parapsilosis prosthetic valve endocarditis. Diagn Microbiol Infect Dis 1997;29:147153.Google Scholar
47.Fowler, SL, Rhoton, B, Springer, SC, Messer, SA, Hollis, RJ, Pfaller, MA. Evidence for person-to-person transmission of Candida lusitaniae in a neonatal intensive-care unit. Infect Control Hosp Epidemiol 1998;19:343345.Google Scholar
48.Pfaller, MA, Messer, SA, Houston, A, et al.National epidemiology of mycoses survey: a multicenter study of strain variation and antifungal susceptibility among isolates of Candida species. Diagn Microbiol Infect Dis 1998;31:289296.CrossRefGoogle ScholarPubMed
49.Huang, YC, Lin, TY, Leu, HS, Peng, HL, Wu, JH, Chang, HY. Outbreak of Candida parapsilosis fungemia in neonatal intensive care units: clinical implications and genotyping analysis. Infection 1999;27:97102.Google Scholar
50.Shin, JH, Kook, H, Shin, DH, et al.Nosocomial cluster of Candida lipoidica fungemia in pediatric patients. Eur J Clin Microbiol Infect Dis 2000;19:344349.Google Scholar
51.Rodero, L, Hochenfellner, F, Demkura, H, et al.Nosocomial transmission of Candida albicans in newborn infants. Rev Argent Microbiol 2000;32:179184.Google Scholar
52.Baran, J Jr, Muckatira, B, Khatib, R. Candidemia before and during the fluconazole era: prevalence, type of species and approach to treatment in a tertiary care community hospital. Scand J Infect Dis 2001;33:137139.Google Scholar
53.Rennert, G, Rennert, HS, Pitlik, S, Finkelstein, R, Kitzes-Cohen, R. Epidemiology of candidemia: a nationwide survey in Israel. Infection 2000;28:2629.Google Scholar
54.Abraira, V, Pérez de Vargas, A. Multivariate Methods in Biostatistics. Madrid: Editorial Centro de Estudios Ramón Areces; 1996.Google Scholar
55.Roilides, E, Kadiltsoglou, I, Zahides, D, Bibashi, E. Invasive candidosis in pediatric patients. Clin Microbiol Infect 1997;3:192197.Google Scholar
56.Saiman, L, Ludington, E, Pfaller, M, et al.Risk factors for candidemia in neonatal intensive care unit patients: the National Epidemiology of Mycosis Survey study group. Pediatr Infect Dis J 2000;19:319324.Google Scholar
57.Nucci, M, Silveira, MI, Spector, N, et al.Fungemia in cancer patients in Brazil: predominance of non-albicans species. Mycopathologia 1998;141:6568.Google Scholar
58.Levy, I, Rubin, LG, Vasishtha, S, Tucci, V, Sood, SK. Emergence of Candida parapsilosis as the predominant species causing candidemia in children. Clin Infect Dis 1998;26:10861088.Google Scholar
59.Stamos, JK, Rowley, AH. Candidemia in a pediatric population. Clin Infect Dis 1995;20:571575.Google Scholar
60.MacDonald, L, Baker, C, Chenoweth, C. Risk factors for candidemia in a children's hospital. Clin Infect Dis 1997;26:642645.CrossRefGoogle Scholar
61.Weems, JJ Jr.Candida parapsilosis: epidemiology, pathogenicity, clinical manifestations, and antimicrobial susceptibility. Clin Infect Dis 1992;14:756766.CrossRefGoogle ScholarPubMed
62.Saxen, H, Virtanen, M, Carlson, P, et al.Neonatal Candida parapsilosis outbreak with a high case fatality rate. Pediatr Infect Dis J 1995;14:776781.Google Scholar
63.Pfaller, MA. Epidemiology of candidiasis. J Hosp Infect 1995;30(suppl):329338.CrossRefGoogle ScholarPubMed
64.Pfaller, MA, Messer, SA, Hollis, RJ. Variations in DNA subtype, antifungal susceptibility, and slime production among clinical isolates of Candida parapsilosis. Diagn Microbiol Infect Dis 1995;21:914.Google Scholar