A Clinical Study on Nosocomial Candidemia

Lee, Kiehl Hyung; Kim, Mi Ran

Abstract

BACKGROUND
Nsocomial candidemia has increased during the last decade. We studied the clinical features, underlying illnesses, risk factors, and outcome of nosocomial candidemia patients.
METHODS
We reviewed 137 admitted patients with nosocomial candidemia at Hangang Sacred Heart Hospital from Jan., 1990 to Dec., 1996.
RESULTS
The annual occurrence of nosocomial candidemia from 1990 to 1996 was 2, 0, 4, 15, 45, 49, and 22, respectively. There were 99 males and 38 females, with a mean age of 37.9+/-15.6 years. Burn was the most common underlying illness(80.3%). Identified Candida species were C. albicans(68.0%), C. parapsilosis(25.0%), C. tropicalis, C. guilliermondii, and C. glabrata. The risk factors of candidemia were ICU care, broad-spectrum antibiotic therapy, central venous catheter insertion, and parenteral hyperalimentation. Concomitant focal candidal infections occurred in 71 patients and concomitant bacterial infections developed in 41 patients. Main clinical features were fever, leukocytosis, and tachypnea. Chorioretinitis developed in 6 patients by C. albicans and C. parapsilosis in five and one case, respectively. Overall mortality rate was 35.8% with lower mortality in cases with burn, antifungal treatment, and removal of central venous catheter.
CONCLUSION
When fever persists despite the use of broad-spectrum antibiotics in burn patients or otherwise immunocompromised hosts, empirical antifungal treatment along with removal of central venous catheter and an ophthalmologic examination should be considered.