Has the epidemiology of nosocomial candidemia changed?

OBJECTIVE: To assess changes in the epidemiology of nosocomial candidemia in the post-fluconazole era among hospitalized patients using a case-control study design. DESIGN: Candidemia case-patients were matched 1:1 on diagnosis, age, and length of stay with control-patients. Conditional logistic regression was used to determine predictors and outcomes of candidemia. Treatment regimens and compliance with national practice guidelines were compared among case-patients. SETTING: Barnes-Jewish Hospital, a 1,278-bed, tertiary-care center affiliated with Washington University School of Medicine, St. Louis, Missouri. PARTICIPANTS: Patients admitted from January 1 to December 31, 2000. Case-patients were identified through the hospital microbiological surveillance system and matched with control-patients. RESULTS: Predictors of candidemia included Hickman catheters (odds ratio [OR], 9.53; 95% confidence interval [CI₉₅], 1.34 to 68.01), gastric acid suppressants (OR, 6.38; CI ₉₅, 2.33 to 17.43), nasogastric tubes (OR, 3.69; CI₉₅, 1.27 to 10.78), antibiotics (OR, 1.46; CI₉₅, 1.15 to 1.86), and admission to the intensive care unit (OR, 6.40; CI₉₅, 2.12 to 19.31). The crude case-fatality rate was 40%. Seventeen (15%) of the case-patients received the recommended treatment regimen according to recently published practice guidelines. CONCLUSIONS: The epidemiology of candidemia has changed little at our hospital during the past decade and remains a significant cause of mortality. Further studies on the benefits of preventive therapy will be essential to improve the outcome of this infection.