Candidemia Before and During the Fluconazole Era: Prevalence, Type of Species and Approach to Treatment in a Tertiary Care Community Hospital
Abstract
The characteristics of candidemia before and after the introduction of fluconazole were compared at our institution. In the pre-fluconazole era (1986-89), the incidence of candidemia rose from 0.02% to 13% over the course of 4 y. Candida albicans accounted for 44/66 isolates (67%) and C. glabrata and C. parapsilosis were the predominant non-albicans species (9% each). In one-third of cases antifungal therapy was not given and the overall mortality rate was 55%. During the fluconazole era (1994-97), the incidence of candidemia remained constant between 1994 and 1996 at 0.09-0.11% and dropped to 0.06% in 1997. Bloodstream infection associated with neutropenia increased significantly but only accounted for 13% of cases; antifungal prophylaxis was not employed. The isolation of C. albicans decreased (n = 49; 50%) whereas isolation of both C. parapsilosis (n = 23; 24%) and C. tropicalis (n = 16; 16%) increased. The vast majority of patients received antifungal therapy and the overall mortality rate was 39%. These findings show that the incidence of candidemia rose steadily prior to the fluconazole era and then stabilized in spite of a shift towards non-albicans species. When candidemia was encountered in the fluconazole era, it was rare not to give antifungal treatment.
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Non-albicans species of Candida are increasingly associated with invasive candidiasis.
“Although Candida albicans remains the most common pathogen in oropharyngeal and cutaneous candidiasis, non-albicans species of Candida are increasingly associated with invasive candidiasis [1][2][3][4][5].”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [3]
Optimization of in vitro susceptibility testing of echinocandins against Candida spp. has been difficult.
“The optimization of in vitro susceptibility testing of the echinocandins against Candida spp. has been difficult (18, 177, 213);”
From Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem (2007) · cites this paper as [18]
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- Authors
- Joseph Baran Jr, B. M.
- Affiliations
- John Hospital and Medical Center
- Venue
- Scandinavian Journal of Infectious Diseases
- Publisher
- Informa UK Limited
- Published
- 2001-01
- Volume
- 33
- Issue
- 2
- Pages
- 137-139
- ISSN
- 0036-5548 (ISSN-L)
- 1651-1980
- OpenAlex
- W2158730440
- Cited by
- 70
- References
- 7
- Citations by year
- 2025: 2 · 2022: 1 · 2020: 1 · 2019: 2 · 2016: 2 · 2015: 2 · 2014: 6 · 2012: 3
- FWCI
- 5.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Scandinavian Journal of Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
- Health Sciences › Medicine › Ophthalmology › Ocular Infections and Treatments
- Keywords
- candidemia, fluconazole, Candida albicans, Candida parapsilosis, Candida tropicalis, Candida glabrata, candidemia incidence, antifungal therapy, mortality, antifungal prophylaxis, non-albicans Candida
- MeSH terms
- Adolescent, Adult, Aged, Antifungal Agents, Candida, Candidiasis, Child, Child, Preschool, Drug Utilization, Hospitals, Community, Hospitals, Teaching, Humans, Infant, Middle Aged, Opportunistic Infections, Fluconazole, Incidence, Prevalence, Fungemia
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