Background: Over the past two decades, Candida species have become the fourth most common cause of bloodstream infections (BSIs) among patients in intensive care units (ICUs). Recent studies have documented an increase in the proportion of Candida BSIs due to non-albicans species, especially C. glabrata. Many believe that the shift towards non-albicans species correlates with the increasing use of azole antifungals. Methods: We used the Microbiology laboratory records to identify all adult ICU cases of candidemia at UCDMC, a tertiary care, teaching hospital located in Sacramento, CA, and conducted a retrospective study looking at secular trends from 1998 to 2003. We also reviewed pharmacy purchasing data regarding antifungal use and expressed the data in Defined Daily Doses (DDDs; i.e. 400 mg/day for po and IV fluconazole, 4 mg/kg q 12 hours for po/IV voriconazole, etc). Results: There were 114 cases of candidemia. 55 cases (48%) were due to C. albicans. 31 cases (27%) were due to C. glabrata. Other offending organisms were C. tropicalis (n=12, 10.5%), C. parapsilosis (n=12, 10.5%), C. krusei (n=2, 2%) and C. lusitaniae (n=2, 2%). There was a steady increase in the total number of Candida BSIs between 1998 (n=10) and 2003 (n=31). When pooled together, the non-albicans species were responsible for the majority of Candida BSIs between 1998 and 2001. The trend reversed in 2002 and 2003, when the majority of candidal BSIs were due to C. albicans (61.5% in 2002 and 58% in 2003). The number of admissions to the ICU and the number of intravascular catheters used remained essentially stable over the years. The graph shows the incidence of candidal ICU-acquired BSIs and the number of antifungal DDDs used at our institution between 1998 and 2003. Conclusion: There was no correlation between changing patterns of antifungal use and the shifts in candidal species that were observed at UCDMC between 1998 and 2003.
Full conference title:
42nd Annual Meeting Infectious Diseases Society of America
- Infectious Diseases Society of America 42nd