Influence of gender, age, previous hospitalization and hospital stay on Candida-colonization of patients in a non-surgical ICU

Abstract

Background: The incidence of systemic fungal infections is increasing and their mortality remains high despite all advances in therapy. Accurate diagnostic measures are still difficult to obtain and evaluate in order to determine the need for antifungal treatment. Moreover, Candida species differ substantially in their antimycotic susceptibility. Thus knowledge of species to be expected is crucial for not missing the diagnosis and making the right decision how to treat. Methods: In a prospective study over 30 month we analysed samples from 411 patients (160 women and 251 men, mean age 63.6 years, mean APACHE-II-Score 20.8) admitted to our ICU. Swabs from nostril, throat and anus and specimens of tracheal secretions and urine were taken and cultured on CHROM- or CandID- Agar at 36 °C. The hospitalization history of the patients was investigated. Results: Positive results were found in 43% of all 1868 investigated samples. Concerning the distribution of species, we found Candida albicans in 69%, Candida glabrata in 35% and Candida tropicalis in 8% of all positive specimens. The colonization index was higher in women than in men (mean 0.47 vs. 0.39, p < 0.01) with no significant influence of age. This difference was due to a higher rate of colonization of anus and urine in women (both p < 0.001). The species distribution showed no difference between sexes, but the rate of nonalbicans species rises significantly with age (in females p < 0.05, in males p < 0.01). A hospital stay longer than 7 days before admission to the ICU was linked with a higher rate of colonization (52% vs. 38%) but not with a significant change in species distribution. Patients who had been hospitalized within two years before the current hospital admission, showed a higher rate of colonization (42% vs. 36%) and a higher proportion of non-albicans species (48% vs. 34%). Conclusion: 1. Women are more frequently colonized with yeasts than men, particularly in urine and anal swabs. 2. With advancing age, the proportion of non-albicans species detected is increasing. 3. A longer duration of hospital stay is associated with a higher colonization rate. 4. Repeated hospitalizations are linked with a higher rate of non-albicans species. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive