Abstract
BackgroundEvidence for an increased prevalence of candidaemia and for high associated mortality in the 1990s led to a number of different recommendations concerning the management of at risk patients as well as an increase in the availability and prescription of new antifungal agents. The aim of this study was to parallel in our hospital candidemia incidence with the nature of prescribed antifungal drugs between 1993 and 2003.MethodsDuring this 10-year period we reviewed all cases of candidemia, and collected all the data about annual consumption of prescribed antifungal drugsResultsOur centralised clinical mycology laboratory isolates and identifies all yeasts grown from blood cultures obtained from a 3300 bed teaching hospital. Between 1993 and 2003, 430 blood yeast isolates were identified. Examination of the trends in isolation revealed a clear decrease in number of yeast isolates recovered between 1995–2000, whereas the number of positive blood cultures in 2003 rose to 1993 levels. The relative prevalence of Candida albicans and C. glabrata was similar in 1993 and 2003 in contrast to the period 1995–2000 where an increased prevalence of C. glabrata was observed. When these quantitative and qualitative data were compared to the amount and type of antifungal agents prescribed during the same period (annual mean defined daily dose: 2662741; annual mean cost: 615629 €) a single correlation was found between the decrease in number of yeast isolates, the increased prevalence of C. glabrata and the high level of prescription of fluconazole at prophylactic doses between 1995–2000.ConclusionBetween 1993 and 2000, the number of cases of candidemia halved, with an increase of C. glabrata prevalence. These findings were probably linked to the use of Fluconazole prophylaxis. Although it is not possible to make any recommendations from this data the information is nevertheless interesting and may have considerable implications with the introduction of new antifungal drugs.
Highlights
Evidence for an increased prevalence of candidaemia and for high associated mortality in the 1990s led to a number of different recommendations concerning the management of at risk patients as well as an increase in the availability and prescription of new antifungal agents
As the use of FCZ has increased, it has become more important to screen for azole resistance among bloodstream isolates or an increase in frequency of bloodstream infection due to species other than C. albicans, which have a higher incidence of in vitro azole resistance (e.g., C. glabrata and C. krusei) [14,15]
C. albicans was the predominant species making up 61.5% of isolates
Summary
Evidence for an increased prevalence of candidaemia and for high associated mortality in the 1990s led to a number of different recommendations concerning the management of at risk patients as well as an increase in the availability and prescription of new antifungal agents. Recent statistics in the USA show that these infections are the tenth leading cause of death overall [1] Their true incidence remains unknown, but it is estimated that around 250 000 cases occur annually in the USA alone [2]. Large scale epidemiological studies conducted in Europe [9] and the USA [10] show that Candida species are the fourth most common cause of hospital-acquired bloodstream infection [11]. A longitudinal surveillance of bloodstream infections caused by Candida species was carried out in a 3300 bed teaching hospital during the 10-year period 1993–2003. The results were correlated with the use of FCZ over the same period
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