Epidemiology of Candidemia in Swiss Tertiary Care Hospitals: Secular Trends, 1991–2000

In the paper

“In these institutions, 533,490 blood cultures were performed over a 10-year period. Of these, 52,565 (9.8%) were positive (i.e., cultures yielded any pathogen).”

In the paper

“the overall proportion of nonalbicans species of Candida was 36% in university hospitals and 31% in universityaffiliated hospitals ( ).”

In the paper

“No significant difference was observed between university and university-affiliated institutions.”

In the paper

“the incidence of Candida parapsilosis decreased (1%)”

In the paper

“A progressive increase in the quantities of the parenteral and oral forms that were administered was observed.”

In the paper

“In 2000, most cases of acute leukemia (71%) and transplantations (92%) were reported by university hospitals.”

In the paper

“followed by C. glabrata (15%)”

In the paper

“that of Candida parapsilosis decreased from 6% to 1% ( )”

In the paper

“The overall incidence of infection was 0.49 cases per 10,000 patient-days.”

In the paper

“C. glabrata was the second most common species recovered (14% during 1991-1993 and 15% during 2000).”

In the paper

“Candida species ranked seventh among etiologic agents (2.9% of all bloodstream isolates).”

• Also stated in: § RESULTS · p. 4 · plain

  “Candida species accounted for 2.9% of the bloodstream pathogens (median annual proportion, 2.8%; range, 2.3%-3.4%) and ranked seventh”

In the paper

“The proportion of Candida tropicalis increased from 2% to 9% ( )”

In the paper

“The analysis of hospital characteristics and activities shows a significant increase in the number of blood cultures and transplantations performed”

In the paper

“Resistant nonalbicans isolates of Candida included 5 C. glabrata isolates, 1 C. krusei isolate, 1 Candida norvegiensis isolate, and 1 C. tropicalis isolate.”

In the paper

“In 1991, 2.1 and 5.2 g per 10,000 patient-days were administered intravenously and orally, respectively; in 2000, 12.2 and 17.8 g per 10,000 patient-days were administered, respectively”

In the paper

“Candida organisms ranged from the sixth through ninth most recovered bloodstream pathogens and accounted for 2%-3% of all isolates during this period.”

In the paper

“In Switzerland, one-third of all episodes of candidemia occurred in ICUs, onethird in medical wards (including hemato-oncology units), and one-fourth in surgical wards.”

In the paper

“In 1999-2000, data on fluconazole susceptibility were available for 96 (39%) of 245 Candida isolates, comprising 90 (60%) of 151 isolates from university hospitals and 6 (6%) of 94 from university-affiliated hospitals ( ).”

In the paper

“In 2000, 0.54 episodes per 10,000 patient-days (0.36 episodes per 1000 hospital admissions) and 0.40 episodes per 10,000 patient-days (0.15 episodes per 1000 hospital admissions) were reported in university and university-affiliated hospitals, respectively.”

In the paper

“We conducted a nationwide survey of candidemia during 1991-2000 in 17 university and university-affiliated hospitals representing 79% of all tertiary care hospital beds in Switzerland.”

• Also stated in: § RESULTS · p. 2 · plain

  “A total of 9333 beds representing 79% of all tertiary care hospital beds in Switzerland were included in the survey”

In the paper

“These institutions are distributed across the country and play a key role in the national health care system by serving the majority of the population of Switzerland ( ∼ 6,100,000 [84%] of 7,200,000 residents).”

In the paper

“All laboratories used automated blood culture systems (12 used Bactec [Becton Dickinson] and 5 used BacT/Alert [bioMe ´rieux]), and 7 (44%) of 16 used special blood culture bottles for fungus detection (5 used Bactec Mycosis IC/F vials [Becton Dickinson] and 2 used other types). Recognized standard laboratory techniques for Candida species identification were used by all laboratories [16].”

What the sources say

• Not checked yetcites [16] Warren N, Hazen K. Candida, Cryptococcus, and other yeasts of medical importance. In: Murray PR, ed. Manual of clinical microbiology. Washington, DC: ASM Press, 1999:1184-1199.

In the paper

“All Swiss university hospitals (5 health care centers and 2 independent pediatric hospitals) and a representative sample of university-affiliated tertiary care teaching centers ( ) were included in a retrospective surn p 11 vey.”

In the paper

“All hematopoietic stem cell and solid-organ transplantations are performed in these centers”

In the paper

“Returned questionnaires (from 17 of the 18 hospitals) were checked by the survey coordinators for completeness and consistency. Those with missing data or inconsistencies were returned for completion and/or correction.”

In the paper

“Antifungal susceptibility testing, the quality control of which was based on NCCLS recommendations, was performed in 7 (44%) of 16 laboratories [17].”

What the sources say

• Not checked yetcites [17] NCCLS. Reference method for broth dilution antifungal susceptibility testing of yeasts; approved standard. NCCLS document M27-A. Villanova, PA: NCCLS, 1997.

In the paper

“It provides a longitudinal overview of the secular trends associated with patient-care activities, which is representative of the entire country over a 10-year period.”

In the paper

“A similar evolution was observed in Asia [18].”

What the sources say

• Not checked yetcites [18] Chen YC, 1997, Infect Control Hosp Epidemiol source

In the paper

“Despite the lack of a centralized laboratory, this retrospective study represents the largest European series of candidemia and one of the largest worldwide.”

In the paper

“The incidence of candidemia remained stable, despite increasing high-risk activities, and no shift to azole-resistant Candida species was observed.”

In the paper

“On the other hand, improved infection-control practices might have contributed to such stabilization, despite an increase of high-risk patient-care activities.”

In the paper

“Invasive candidiasis emerged as a major problem in US hospitals in the 1980s [5, 7].”

What the sources say

• Not checked yetcites [5] source
• Not checked yetcites [7] source

In the paper

“However, an inverse trend was observed during 19891999 among ICUs in US hospitals reporting to the NNIS system [8].”

What the sources say

• Not checked yetcites [8] source

In the paper

“The emergence of Candida species with decreased susceptibility or intrinsic resistance to azoles was a major concern in the 1990s.”

In the paper

“Other North American and European investigators confirmed these observations in larger hospital settings [10, 11, 13, 20, 22, 25, 26].”

What the sources say

• Not checked yetcites [10] Abi-Said D, 1997, Clin Infect Dis source
• Not checked yetcites [11] Viscoli C, 1999, Clin Infect Dis source
• Not checked yetcites [13] source
• Not checked yetcites [20] Berrouane YF, 1999, J Clin Microbiol source
• Not checked yetcites [22] source
• Not checked yetcites [25] source
• Not checked yetcites [26] source

In the paper

“This phenomenon was first reported in the United States in neutropenic recipients of bone marrow transplants [9].”

What the sources say

• Not checked yetcites [9] Wingard JR, 1991, N Engl J Med source

In the paper

“Other recent multicenter longitudinal data from Europe are lacking.”

In the paper

“Ten years later, Berrouane et al. [20] observed 0.98 episodes of candidemia per 10,000 patient-days in 1 US tertiary care center.”

What the sources say

• Not checked yetcites [20] Berrouane YF, 1999, J Clin Microbiol source

In the paper

“No significant change was reported in 1 Swiss hospital between 1989 and 2000 [19].”

What the sources say

• Not checked yetcites [19] source

In the paper

“In Europe, contrasting data were reported in the early 1990s-the incidence of candidemia increased in The Netherlands and remained stable in Norway [13, 15].”

What the sources say

• Not checked yetcites [13] source
• Not checked yetcites [15] Sandven P, 1998, J Clin Microbiol source

In the paper

“The distribution of Candida species plays a key role for establishing efficient management strategies [23, 24].”

What the sources say

• Not checked yetcites [23] source
• Not checked yetcites [24] source

In the paper

“In contrast, a study from 1 Swiss university hospital reported no shift to nonalbicans species of Candida, despite a significant increase in fluconazole use between 1989 and 2000 [19].”

What the sources say

• Not checked yetcites [19] source

In the paper

“The role of the widespread use of azoles in the shift to resistant Candida species has been largely debated and remains controversial [12].”

What the sources say

• Not checked yetcites [12] White MH, 1997, Clin Infect Dis source

In the paper

“The species distributions were very close to those reported in Norway during the early 1990s, in Italy during an ECCM survey conducted in the late 1990s, and in Wales [15, 22, 28].”

What the sources say

• Not checked yetcites [15] Sandven P, 1998, J Clin Microbiol source
• Not checked yetcites [22] source
• Not checked yetcites [28] source

In the paper

“Two groups observed an important increase of C. glabrata fungemia in the 1990s and analyzed fluconazole consumption over time.”

In the paper

“Trick et al. [8] recently confirmed these trends in patients in US ICUs.”

What the sources say

• Not checked yetcites [8] source

In the paper

“Voss et al. [13] evaluated the annual nationwide fluconazole use in The Netherlands in kilograms and observed a 4-fold increase between 1990 and 1995.”

What the sources say

• Not checked yetcites [13] source

In the paper

“Similarly, Berrouane et al. [20] observed a substantial increase in fluconazole use, from 3 to 33 g per 10,000 patient-days in 1990 and 1994, respectively.”

What the sources say

• Not checked yetcites [20] Berrouane YF, 1999, J Clin Microbiol source

In the paper

“In institutions where this shift occurred, proportions of C. glabrata and C. krusei were 15%-45% and 5%20%, respectively.”