Decrease in Candidemia Rates Associated with Empiric Use of Amphotericin B and Fluconazole for Nosocomial Fever of Unknown Origin

Abstract

Since 1986, patients with nosocomial fever of unknown origin (NFUO) at Methodist Central Hospital (Memphis) have been initially treated with antibacterial antibiotics if there was a likelihood of infection. If there was no response to therapy and noninfectious causes for the NFUO were eliminated, treatment was then initiated with antifungal agents, notably amphotericin B and fluconazole. Most patients so treated were nonneutropenic and in the intensive care unit (ICU). A retrospective analysis using hospital data collected between 1987 and 1994 suggested that hospitalized patients had an increasing severity of illness during the study period yet a decreasing incidence of candidemia, particularly after 1990 when fluconazole was approved and used frequently for NFUO. From 1988 to 1990, the rate of candidemia per 1000 ICU admissions was 5.56; while from 1991 to 1994, the rate was 2.64 per 1000 ICU admissions (P <.0001). Since the data suggest that early empiric therapy of NFUO with antifungal agents is useful when a patient is at high risk for deepseated candidiasis, a prospective study to evaluate this method of clinical management is indicated.