Community-onset candidemia at a university hospital, 1995-2005
Journal
Journal of Microbiology, Immunology and Infection
Journal Volume
40
Journal Issue
4
Pages
355-363
Date Issued
2007
Author(s)
Abstract
Background and Purpose: Although not all candidemias are hospital-acquired, data on clinical epidemiology for the community-onset candidemia are limited. This retrospective study was conducted to describe predisposing factors and outcomes of community-onset candidemias. Methods: Medical records of patients who were admitted to the National Taiwan University Hospital between January 1, 1995 and May 31, 2005 and had Candida isolated from their blood in the outpatient setting and/or within 48 h of hospitalization (community-onset) were reviewed. Results: A total of 56 episodes of candidemia were reviewed, which included 8 episodes (14.3%) of true community-acquired candidemia occurring in patients with no record of hospitalization within the previous 30 days and without histories of invasive procedures either just before or at the time of admission, and 48 episodes (85.7%) that were health care-associated. The latter included 24 episodes (42.9%) in patients recently discharged from hospitals (within 2-30 days of current admission), 23 episodes (41.1 %) associated with invasive procedures and/or central intravascular lines placed for outpatient therapy, and 1 episode (1.8%) in patients admitted from nursing homes. Gastrointestinal bleeding (46.4%), immunosuppressive therapy (42.9%) and previous antibiotics use (37.5%) were the most common predisposing factors. Diabetes was the single most important predisposing factor in true community-acquired candidemia (62.5%) and had a significantly higher prevalence among these patients than in those with health care-associated candidemias (p=0.035). Candida albicans was the most common isolate (39.7%), followed by Candida tropicalis (22.4%) and Candida glabrata (17.2%). The overall case fatality rate was 55.4% (31/56), and 58.1% (18/31) of this was attributable to candidemia. Multivariate analysis identified higher severity score and lack of antifungal therapy as having an independent and adverse influence on outcome. Conclusions: Up to 85.7% of community-onset candidemias are health care-associated. There is a conceptual and practical need for a new classification for the spectrum of acquisition of infection, wherein the new category of health care-associated infection will have implications for the selection of empirical therapy. ? 2007 Journal of Microbiology, Immunology and Infection.
SDGs
Other Subjects
amphotericin B deoxycholate; antibiotic agent; antifungal agent; antineoplastic agent; fluconazole; histamine H2 receptor antagonist; immunosuppressive agent; micafungin; proton pump inhibitor; steroid; adult; aged; antibiotic therapy; article; cancer chemotherapy; cancer patient; Candida; candidemia; central venous catheterization; chronic kidney failure; chronic lung disease; community; diabetes mellitus; digestive system ulcer; disease predisposition; disease severity; drain; female; fungus isolation; gastrointestinal hemorrhage; hematopoietic system tumor; high risk patient; hospitalization; human; immunosuppressive treatment; liver cirrhosis; major clinical study; male; mortality; multivariate analysis; outpatient; parenteral nutrition; risk factor; solid tumor; steroid therapy; Taiwan; treatment outcome; univariate analysis; university hospital; urinary tract obstruction; urine catheter; whole body radiation; Adult; Aged; Aged, 80 and over; Candida; Candidiasis; Causality; Community-Acquired Infections; Comorbidity; Cross Infection; Female; Fungemia; Hospitals, University; Humans; Male; Middle Aged; Retrospective Studies; Taiwan
Type
journal article