[Cryptococcosis in AIDS patients: case study from 1996 to 2006 in Paroissien Hospital]

Clinic, epidemiological and microbiological characteristics of 128 episodes of cryptococcosis were retrospectively evaluated in 106 positive HIV patients hospitalized at the Paroissien Hospital on period 1996-2007. There were 75 male and 31 female patients, with a median age of 34 years, ranging from 20 to 68 years. Addiction to intravenous drugs was the main cause of HIV infection in 55 patients (51.9%). Cryptococcosis was detected as single episode in 85 patients (80.2%) and as relapse in 19 (17.9%). It appeared as the first marking disease in 36 patients (34.0%). Diagnosis was established in 116 episodes by CSF study (Indian ink, culture, antigen detection), in 9 cases by Cryptococcus sp. recovery from blood cultures, and in 3 cases by antigen detection in patient's serum with a latex reactive. Neurological symptomatology, with headache and fever as the most common signs, was presented by 89.6% of patients. Induction treatment was done in all cases with amphotericin B, and maintenance treatment was carried out with fluconazole. Mortality rate was 35.8%, being higher in those patients who had suffered relapses (41.3%) compared to those who presented a first episode of the mycosis (33.3%).

A retrospective analysis of antifungal susceptibilities of Candida bloodstream isolates from Singapore hospitals

INTRODUCTION

Worldwide, Candida albicans is the most common Candida species implicated in bloodstream infections. However, the proportion of non-albicans bloodstream infections is increasing. Fluconazole resistance is known to be more common in non-albicans species, but is also reported in C. albicans. This retrospective study was performed to determine the species epidemiology of Candida bloodstream infections in Singapore hospitals, and to perform susceptibility testing to a range of antifungal drugs.

MATERIALS AND METHODS

Candida spp. isolated from bloodstream infections from October 2004 to December 2006 were collected from 3 participating hospitals: a tertiary referral hospital (Singapore General Hospital), a secondary referral hospital (Changi General Hospital) and an obstetrics/paediatric hospital [KK Women's and Children's Hospital (KKWCH)]. Isolate collection was also retrospectively extended to January 2000 for KKWCH because of the limited number of cases from this hospital. Isolates were identified by a common protocol, and antifungal susceptibility testing was performed by microbroth dilution (Sensititre One, Trek Diagnostics, United Kingdom).

RESULTS

The most common isolates were C. albicans (37%), C. tropicalis (27%) and C. glabrata (16%). There were differences in species distribution between institutions, with C. parapsilosis and C. albicans predominant in KKWCH, and C. albicans and C. tropicalis predominant in the other 2 institutions. Fluconazole resistance was detected in 3.2% of all Candida spp., and 85.3% were classified as susceptible. All C. albicans and C. parapsilosis were susceptible to fluconazole and voriconazole, while susceptibility to fluconazole was much more variable for C. glabrata and C. krusei.

CONCLUSION

This study shows that C. albicans remains the predominant Candida species isolated from bloodstream infections in the 3 participating hospitals. However, non-albicans species accounted for nearly two-thirds of all cases of candidaemia. Resistance to fluconazole was uncommon, and was generally confined to C. krusei and C. glabrata.

Adult candidemia at a medical center in northern Taiwan: a retrospective study

BACKGROUND AND PURPOSE

Candidemia has been associated with a very high mortality. This study evaluated the predictors of candidemia-related mortality at a teaching hospital in northern Taiwan.

METHODS

We conducted a retrospective analysis of adult patients with candidemia between September 2003 and May 2005. A stepwise logistic regression analysis was performed to determine the predictors of candidemia-associated mortality. All Candida isolates were identified to species by use of the ATB ID 32C kit and their susceptibilities to antifungal agents were tested by ATB Fungus 2 system.

RESULTS

179 episodes in 174 adult patients with candidemia were identified retrospectively. The predictors of mortality included duration of prior antibiotics >or=28 days, Acute Physiology and Chronic Health Evaluation (APACHE) II score >or=23 and retention of central venous catheters (CVCs). There was no statistically significant association between the time to the start of antifungal therapy and mortality from nosocomial candidemia. In addition, there was no significant association between the time to CVC removal and mortality after stratification by APACHE II score.

CONCLUSIONS

Despite effective antifungal therapy after the onset of candidemia in more than half of the patients studied, mortality remained very high, especially in the groups with longer duration of prior antibiotic treatment, higher APACHE II score and CVC retention. Timing of CVC removal after onset of candidemia was not correlated with mortality.

[Infection associated with hemodialysis and peritoneal dialysis catheters]

Catheter-related infections in hemodialysis (HD) and peritoneal dialysis (PD) are one of the most common causes of morbidity and mortality in patients with end-stage renal disease. Staphylococcus aureus in HD patients and S. aureus and Pseudomonas aeruginosa in PD patients are the most common causative organisms isolated. Currently, the diagnostic tests with highest yield in suspected catheter-related infection in HD patients have not been established, and tests used for central venous catheters (CVC) in general are applied. Management of the infected HD catheter and the use of antimicrobial therapy are similar to the measures used for other CVCs, with some specific recommendations. Peritonitis is the most severe complication in PD patients. Improving hygiene conditions in catheter insertion, treatment of S. aureus nasal carriers, regular treatment of the catheter's exit site, and antibiotic lock therapy have been associated with a reduction of infectious episodes in HD and PD patients.

[Epidemiological study of invasive nosocomial candidiasis in 2 teaching hospitals in Beijing]

OBJECTIVE

To investigate the epidemiological characteristics of invasive nosocomial candidiasis in teaching hospitals in Beijing.

METHODS

The clinical data of consecutive cases diagnosed as with nosocomial candidiasis hospitalized in Beijing Chaoyang Hospital (CYH) (n=43) and Peking Union Medical College Hospital (PUMCH) (n=34) from January 2004 to September 2006 were retrospectively analyzed to evaluate the incidence and mortality, and the relationship between antifungal therapy and outcomes. The minimum inhibitory concentrations (MICs) for Candida spp were determined by microdilution method.

RESULTS

The incidence rates of nosocomial candidiasis of CYH and PUMCH were 0.053% and 0.025% respectively in 2004, and increased to 0.074% and 0.049% respectively in 2006. Candidemia accounted for 55.8% (43/77) of the Candida infection, followed by intra-abdominal infection (26.0%, n=20), intra-thoracic infection (9.1%, n=7), and biliary tract infection (7.8%, n=6). The species mostly frequently isolated were Candida albicans (57.1%), followed by C. tropicalis (19.5%), C. glabrata (14.3%), and C. parasitosis (2.6%). The susceptibility rates of C. albicans, C. tropicalis, C. glabrata, and C. parasitosis to fluconazole were 97.7%, 86.7%, 63.6%, and 100% respectively. No isolates were resistant to amphotericin B. The crude mortality rate of Candida infection was 37.7%. The mortality rate of the candidemia patients who did not receive systemic antifungal therapy was 72.7%, significantly higher than those who received antifungal therapy (37.5%, P = 0.043). Most patients received fluconazole as the first choice (91.7% in PUMCH and 79.2% in CYH) with the survival rates of 63.6% and 52.6% respectively. Conclusion With high morbidity and mortality, invasive nosocomial candidiasis is a big problem in teaching hospitals. Further investigation is necessary to evaluate the incidence and to identify which antifungal agents are most protective for candidiasis.

Epidemiology and clinical outcome of candidaemia among Jordanian newborns over a 10-year period

This retrospective study includes all newborn patients with culture proved candidaemia who were admitted to the neonatal intensive care unit of Jordan University Hospital through the period January 1995 to June 2006. Among 24 patients included, 13 (54.2%) died. The incidence of candidaemia was 0.27%, the mean age at diagnosis 25.9 d and the mean gestational age at birth 34.6 weeks. Species most frequently isolated were Candida albicans (50%) and C. krusei (20%). Previous gastrointestinal pathology was present in 41.7% of the cases. A comparison of cases due to C. albicans with those due to other species of Candida revealed no statistical differences in terms of demographic factors, age at onset of disease, mortality, clinical manifestations or risk factors. Based on our results, empirical antifungal therapy should be considered in neonates who have gastrointestinal pathology and other risk factors.

[Epidemiological features of Candida infections detected in intensive care units and risk factors affecting mortality]

The aim of this study was to describe the epidemiological features of nosocomial Candida infections in intensive care units and to detect the risk factors which increase the mortality rate. A total of 940 patients hospitalized in ICUs of Gulhane Military Medical Academy Haydarpasa Training Hospital, Istanbul, between January 01 and December 31, 2006 were prospectively enrolled into this study. Candida spp. were isolated from various clinical specimens (blood, urine, respiratory tract, wound) in 48 patients. Of these patients, 50% were male and 50% were female, and the mean age was 63.66 +/- 22.72 (age range: 8-92) years. The mean duration of hospital stay was 36.25 +/- 44.51 (min: 1, max: 90) days. Thirty five Candida infection attacks were observed in 29 of 48 patients. C. albicans was isolated in 18 infections and non-albicans Candida spp. in 17 infections. Nosocomial infection rate due to Candida spp. was 3.22 per 1000 patient-days. The most common Candida infections were bloodstream (42.9%) and urinary tract infections (37.1%). At the time of diagnosis, 89.6% of patients were being hospitalized for more than ten days and 69% of the patients were using three or more wide spectrum antibiotics. Diabetes mellitus and cardiovascular diseases were the most frequently detected co-morbid diseases. The overall mortality rate was 55.2%. Predictors of adverse outcome were diabetes mellitus (p= 0.016), need for mechanical ventilation (p= 0.010) and infection with non-albicans Candida spp. (p= 0.002). In conclusion, Candida infections in the intensive care patients are associated with high mortality. Mortality due to Candida infections could be reduced by defining the risk factors and starting preemptive antifungal treatment to patients who are under risk.

[Study on the morbidity and pathogens of patients with candidemia at the intensive care unit]

OBJECTIVE

To study the mortality and pathogens of candidemia in patients at hospital intensive care unit (ICU).

METHODS

Clinical data of candidemia cases admitted to ICU of the First Affiliated Hospital of Zhejiang University in recent five years were analyzed retrospectively. Chi-square test and logistic regression analysis were used.

RESULTS

A total of 6034 patients were discharged in the ICU over the 5-year period, and 75 were diagnosed as candidemia. The annual morbidity rates of candidemia from 2002 to 2006 were 0.67%, 1.46%, 1.21%, 1.15% and 1.56%, respectively. 36 cases died of the disease, with the mortality as 48%. The annual mortality rates from 2002 to 2006 were 50%, 64%, 33%, 41% and 52%, respectively. In this period, 78 positive blood culture samples strains from ICU were identified as Candida, among which Candida albicans, C. glabrata, C. tropicalis, C. parapsilosis and C.lusitaniae accounted for 46.2%, 21.7%, 17.9%, 12.8% and 1.3%, respectively. Average APACHE II scores of the patients with candidemia were 17.21 +/- 4.38 (range: 9-27). During the 5-year period, the annual morbidity of candidemia had increased from 0.67% to 1.56% while the ratios of candidemia due to non-albicans Candida species (NAC) increased from 50.0% to 56.5%. When analyzing the C. albicans group and NAC group with single factor and multiple conditional logistic regression method, we found that age (66 +/- 14 vs. 53 +/- 16, P = 0.001, OR = 1.077, 95% CI: 1.031- 1.124) and hypoproteinemia (61.8% vs. 81.6%, P = 0.033, OR = 0.206, 95% CI: 0.048-0.880) both showed statistical significance.

CONCLUSION

Candidemia cases in ICU increased gradually and causing higher mortality. The number of patients with candidemia caused by NAC increased in recent 5 year. Age was proved to be a risk factor for those candidemia caused by C. albicans. Hypoproteinemia was proved to be risk factors for the candidemia caused by NAC.

[Prevalence and antimicrobial susceptibility patterns of microorganisms causing bacteremia and fungemia in pediatric oncology patients]

The purpose of our research was to know the frequency of microorganisms causing bacteremia and/or fungemia in oncology patients from Hospital de Niños de Córdoba, as well as to describe the antimicrobial susceptibility patterns of bacteria isolated from January 2006 to April 2007. A total of 59 bacteremia and fungemia cases in 44 patients were studied. From the total number of isolations, 45.8% were gram-negative bacilli, 35.6% were gram-positive cocci, and 18.6% were yeasts. The global distribution of the most prevalent microorganisms was the following: Klebsiella spp. 15.3%; Staphylococcus aureus and Candida parapsilosis 11.9%; coagulase-negative staphylococci 10.2%; Escherichia coli 8.5%, and Pseudomonas aeruginosa 6.8%. More than 40% (41.2%) of enterobacteria showed an extended-spectrum beta-lactamase phenotype, and 20.0% of non-fermenting gram-negative bacilli were multi-resistant to tested antibiotics, while 38.5% of Staphylococcus spp. were methicillin-resistant. In conclusion, the most prevalent microorganisms were gram-negative bacilli, and within this group, enterobacteria evidenced a higher percentage of resistance to tested antibiotics.

Prevalence and susceptibility profile of Candida metapsilosis and Candida orthopsilosis: results from population-based surveillance of candidemia in Spain

We describe the prevalences and susceptibility profiles of two recently described species, Candida metapsilosis and Candida orthopsilosis, related to Candida parapsilosis in candidemia. The prevalences of these species (1.7% for C. metapsilosis and 1.4% for C. orthopsilosis) are significant. Differences observed in their susceptibility profiles could have therapeutic importance.

[Risk factors associated with multiple-species candidemia]

The incidence of fungemia has increased over the past decade. Multiple-species candidemia (MSC) has been infrequently reported. From 1998 to 2004, of 155 patients with diagnosis of candidemia at the Hospital de Clinicas (University of Buenos Aires), seven cases of MSC were identified (6 adults and 1 newborn) and compared with 21 cases of similar age and sex with monomicrobial candidemia. There were no differences in clinical data and outcome, except for the mediana duration of hospital stay (39 days for patients with MSC vs. 18 days for patients with monomicrobial candidemia, the mean time of central venous catheter permanence previous to candidemia (32 days for patients with MSC vs. 12 days for patients with monomicrobial candidemia and the duration of candidemia (5 days for MSC and 1 day for monomicrobial candidemia. In conclusion, although MSC episodes are less common than those caused by monomicrobial candidemia, modifiable risk factors such as duration of hospitalization and central venous catheter permanence account for the development of MSC.

[Is there a change in ecology of Candida species incriminated in fungemia? A 7 years study at Foch Hospital]

Some Candidemia studies have documented changes in epidemiology of Candida species and some species were reported as emerging species. We conducted a study over a 6 years period and until 2005 we do not noticed any change in epidemiology of Candida even if Candida albicans still the most common species followed by Candida glabrata. No increase of candidemia was observed from 2000 to 2005 and we observed a decrease during the year 2006, this fact have to be confirm and may be related to other data: reinforcement of hygienic measures in our hospital, changes in treatment or preemptive treatment of yeasts and fungi with new azoles or candines molecules. On another side, patients from intensive care units and patients suffering of cancer were, as expected, the most represented population in our study.

[Spectrum and risk factors of invasive fungal infection]

In recent years, invasive fungal infection has become a growing problem in immunosuppressed patients. Simultaneously, changes in medical practice, such as the use of anti-Candida prophylaxis with azoles, has led to a shift in the epidemiology of these infections from Candida spp. to Aspergillus and other filamentous molds. Moreover, new risk factors for invasive fungal infection have been identified and the time of onset is different from that seen a decade ago. Recognition of these trends in patients receiving novel immunosuppressive regimens has important implications for the clinical management of fungal infection in this population.

[Hospital-acquired bacteraemia and fungaemia. A regional study with national implications]

INTRODUCTION

Bacteraemia and fungaemia are among the most frequent hospital-acquired infections. There are only few population-based studies describing long-term trends of occurrence and mortality, and we therefore present such data from North Jutland County.

MATERIALS AND METHODS

All bacteraemias and fungaemias in North Jutland County were recorded in a database during a 15-year period, 1992 through 2006. The population was 0.5 million and the inhabitants were provided with secondary and tertiary care from public hospitals in the county.

RESULTS

A total of 14,977 cases were recorded, 12,275 of which were incident cases. 5,843 (39.0%) were hospital-acquired, 6,576 (43.9%) were community-acquired, and 2,471 (16.5%) were health-care related. The origin was unknown in 86 (0.6%) cases. The numbers of hospital-acquired cases increased 15% during the study period. A number of microorganisms contributed to this rise and the relative increase was largest for Pseudomonas aeruginosa, enterococci and yeasts. In 2005 the rate of hospital-acquired cases was 7.0 (95% confidence interval 6,4-7,8) per 1000 patients and 8.9 (8,1-9,8) per 10,000 hospital days. Overall 30-day mortality was 27.1% (25.8-28.4%) but there was considerable variation among specialities: medicine 30.7% (28.6-33.0%), surgery 19.2% (17.4-21.1%), intensive care 39.9% (36.5-43.4%) and paediatrics 13.1% (8.7-18.7%).

CONCLUSION

The rates of hospital-acquired bacteraemia and fungaemia increased during most of the study period. Mortality remains high and access to precise and detailed data should promote studies of risk, prognosis and prevention.

Changing pattern of candidaemia 2001–2006 and use of antifungal therapy at the University Hospital of Vienna, Austria

A retrospective survey of candidaemia between 2001 and 2006 was performed at the University Hospital of Vienna, a 2200-bed centre with large organ transplantation and haematology-oncology units. The incidence rate of Candida spp. in blood cultures increased from 0.27 cases/1000 admissions in 2001 to 0.77 cases/1000 admissions in 2006 (p <0.005). The incidence of candidaemia caused by Candida albicans and by non-albicans Candida spp. both increased during this period; although there was a trend towards an increased incidence (37%) of non-albicans Candida spp., particularly Candida glabrata, in surgical wards, C. albicans remained the predominant pathogen (63%). In the haematology-oncology unit, C. albicans remained the leading pathogen (23/29 isolates, 79%), followed by Candida tropicalis and C. glabrata (2/29, 7% each), Candida sake and Candida lusitaniae (1/29, 3% each). The overall survival rate was 43.8%, ranging from 32.8% in 2004 to 63.6% in 2002. In total, 108 (33.2%) patients died within 4 weeks of the first isolation of Candida spp. from blood; 58 (54%) of these patients died within the first 7 days, and a further 34 patients died within the next 3 months. Fluconazole was used extensively (24 701.5 defined daily doses), followed by amphotericin B (8981.4 defined daily doses), during 2005. The consumption of antifungal agents increased continuously (p <0.05) because of increased use of voriconazole and caspofungin. Although the numbers of susceptible patients remained unchanged, the net increase in the number of cases of candidaemia warrants a re-evaluation of the risk-factors and the use of improved diagnostic procedures for invasive fungal infections.

One year prospective survey of Candida bloodstream infections in Scotland

A 12 month survey of candidaemia in Scotland, UK, in which every Scottish hospital laboratory submitted all blood isolates of yeasts for identification, strain typing and susceptibility testing, provided 300 isolates from 242 patients, generating incidence data of 4.8 cases per 100,000 population per year and 5.9 cases per 100,000 acute occupied bed days; 27.9 % of cases occurred in intensive care units. More than half the patients with candidaemia had an underlying disease involving the abdomen, 78 % had an indwelling intravenous catheter, 62 % had suffered a bacterial infection within the 2 weeks prior to candidaemia and 37 % had undergone a laparotomy. Candida albicans was the infecting species in 50 % of cases, followed by Candida glabrata (21 %) and Candida parapsilosis (12 %). Seven cases of candidaemia were caused by Candida dubliniensis, which was more prevalent even than Candida lusitaniae and Candida tropicalis (six cases each). Among C. glabrata isolates, 55 % showed reduced susceptibility to fluconazole, but azole resistance among other species was extremely low. Multilocus sequence typing showed isolates with high similarity came from different hospitals across the country, and many different types came from the hospitals that submitted the most isolates, indicating no tendency towards hospital-specific endemic strains. Multiple isolates of C. albicans and C. glabrata from individual patients were of the same strain type with single exceptions for each species. The high prevalence of candidaemia in Scotland, relative to other population-based European studies, and the high level of reduced fluconazole susceptibility of Scottish C. glabrata isolates warrant continued future surveillance of invasive Candida infections.

Predominance of Candida tropicalis bloodstream infections in a Singapore teaching hospital

An 18-month epidemiologic investigation of Candida bloodstream infections in a Singapore hospital identified 52 candidemic patients: 36% of whose infections were caused by C. tropicalis, 29% were due to C. albicans, 10% with C. parapsilosis and 21% involved C. glabrata. A predominant clonal C. tropicalis strain was demonstrated. No association with ICU stay, prior exposure to fluconazole/broad-spectrum antibiotics or increased mortality was found in this apparent shift towards non-C. albicans Candida species as the primary agents of candidemia.

Polymicrobial bloodstream infections involving Candida species: analysis of patients and review of the literature

Candida species are the 4th most common cause of nosocomial bloodstream infections in North America. It is not widely appreciated, however, that many of these infections are polymicrobial, that is, that bacteria and occasionally more than 1 species of Candida are present in the same blood culture bottle. Analysis of 2 groups of candidemic patients and a review of the literature were performed. Review of 141 candidemic patients from 8 Veterans Affairs hospitals and 231 patients from a tertiary care hospital with transplant services was performed. Of the 372 patients with candidemia, 100 (27%) had polymicrobial blood cultures: 88 patients (24%) had synchronous bacteremia and 12 patients (3%) had more than 1 species of Candida. One hundred bacteria were isolated from these patients, 69 were Gram positive, and 31 were Gram negative. Candidemia was shown to occur in a setting of polymicrobial bacteremia extending over days, whereas Staphylococcus aureus and coagulase-negative Staphylococcus were less frequently associated with polymicrobial bloodstream infections. Review of more than 8000 reported episodes of candidemia revealed high rates of polymicrobial infection occurring with candidemia. Of blood cultures isolating Candida, 23% were polymicrobial and 4% had more than 1 species of Candida. Thus, almost 1 in 4 patients with candidemia will have a polymicrobial bloodstream infection. As detection of bloodborne infections evolves toward nonculture methodologies, documentation of the frequency of polymicrobial bloodstream infections involving Candida is important. This finding may have treatment implications for clinicians.

Candida parapsilosis fungemia in neonates: genotyping results suggest healthcare workers hands as source, and review of published studies

An outbreak of Candida parapsilosis fungemia involving 17 neonatal intensive care unit (NICU) patients was studied. There were 14 blood culture and nine colonizing isolates from other sites available. The hands of NICU healthcare workers (HCW) yielded eight isolates. Screening of the isolates by random amplified polymorphic DNA (RAPD) method showed only three profiles. Typing by restriction fragment length polymorphism (RFLP) revealed all blood isolates were RFLP subtype VII-1. Among the nine infant colonizing isolates, there were four different RFLP subtypes; four of the isolates were subtype VII-1. Seven of the eight isolates from HCW were RFLP subtype VII-1. The majority of infant colonizers were not found in the blood, suggesting a possible direct spread of the epidemic subtype VII-1 strain from HCW hands to infant blood. The source of the infant colonizing strains is unclear, but non-VII-1 strains may be largely of maternal origin and VII-1 strains from HCW. These findings reinforce prior studies that have implicated HCW hands as the source of nosocomial, including neonatal, fungemia.

Risk factors for candidaemia in critically ill patients: a prospective surveillance study

Candidaemia is frequently a life-threatening complication in patients admitted to the intensive care unit (ICU). To assess the risk factors for candidaemia in critically ill patients with prolonged ICU stay, a total of 1765 adult patients admitted for at least 7 days to 73 medical-surgical ICUs of 70 tertiary care hospitals in Spain participated in a prospective cohort study. Candidaemia was defined as recovery of Candida spp. from blood culture. Sixty-eight episodes of candidaemia occurred in 63 patients, representing 35.7 episodes per 1000 ICU patients admitted, with an incidence rate of 1.5 episodes per 1000 days of ICU stay. Causative fungi were C. albicans in 57.1% of cases and non-albicans Candida spp. in 42.9%. In the multivariate analysis, independent factors significantly associated with candidaemia were Candida colonisation (OR = 4.12, 95% CI: 1.82-9.33), total parenteral nutrition (OR = 3.89, 95% CI: 1.73-8.78), elective surgery (OR = 2.75, 95% CI: 1.17-6.45) and haemofiltration procedures (OR = 1.96, 95% CI: 1.06-3.62). In the ICU setting in Spain and in patients who have stayed in units for >7 days, more than half of cases of candidaemia were caused by C. albicans. Risk factors for candidaemia identified included Candida colonisation, elective surgery, total parenteral nutrition and haemodialysis.

Management of venous port systems in oncology: a review of current evidence

BACKGROUND

Over the last decades, many changes have occurred in oncology with new chemotherapy combinations and more complex application schemes becoming available. Central venous catheters and implantable venous port systems have become widely used and have facilitated the problem of vascular access. However, important complications are associated with permanent central venous catheters.

MATERIAL AND METHODS

This review summarizes evidence on venous port system use published in Medline up to February 2007. Moreover, recent guidelines for the prevention and management of catheter-related infections issued by the Infectious Diseases Society of America, the American College of Critical Care Medicine, the Society for Healthcare Epidemiology of America, the Center for Disease Control and Prevention, Atlanta, and the Infectious Diseases Working Party of the German Society of Hematology and Oncology are included.

RESULTS

Sterile precautions are essential when implanting and accessing port systems. Infections must be treated with adequate antimicrobial therapy. Catheter-related thromboembolic complications were found at a rate of 12-64% in retrospective studies. Five current clinical trials investigated the effect of prophylactic anticoagulation with either low molecular weight heparin or warfarin in cancer patients with central venous devices. On the basis of these results, routine anticoagulation cannot be recommended.

CONCLUSIONS

This article reviews the current literature on long-term complications of venous port systems, focusing on infection and thrombosis. In addition, it summarizes the evidence regarding routine maintenance of port systems in follow-up care.

Estado actual del diagnóstico precoz de las infecciones invasoras causadas por Aspergillus y otros hongos filamentosos emergentes

The usefulness of surrogate markers in the diagnosis of invasive fungal infections caused by Aspergillus and other emerging mycelial fungi is based on the ability of surrogate markers to detect the infection caused by different species of mycelial fungi. Conventional microbiological methods for diagnosis of fungal disease are slow and insensitive. Antigen based assays or measurement of (1-3)-beta-D-glucan in blood have been developed and validated in clinical laboratories. We review these diagnostic contemporary tools, their clinical application and impact.

[Surveillance results of nosocomial infections of the ICU in Kenézy Hospital, based on two years data]

INTRODUCTION

According to data in the literature, the number of nosocomial infections in the ICU is far higher than in non-ICU patients. As a result of improving lifesaving technologies, the risk of nosocomial infections increases in ICUs. Utilization of epidemiological methods is recommended for the detection and follow up of nosocomial infections.

AIMS

Prospective surveillance to assess the epidemiology of nosocomial infections in an ICU.

METHODS

Kenézy Hospital is a country hospital with 1637 beds and a 16-bed central ICU. During the investigated period (01. 04. 2004-31. 03. 2006) 1490 patients, with a total 8058 ICU days, were hospitalised in the mixed medical-surgical ICU. The commonest primary diagnosis were respiratory failure, multiple trauma and head injury. Surveillance was performed by a trained infection control nurse and was supervised by an infection control physician and infectious disease physician. CDC definitions were used to define nosocomial infections.

RESULTS

A total of 194 nosocomial infections in 134 patients were detected during the study period. The overall incidence and incidence density of nosocomial infections were 13.0 per 100 patients and 24.0 per 1000 patient-days. Respiratory tract infections (44.3%) were the most frequent nosocomial infection, followed by urinary tract (21.1%) and bloodstream infections (20.1%).

CONCLUSIONS

Nosocomial surveillance is useful in detecting nosocomial infections in ICU. A multidisciplinary approach and partnership between the physicians and infection control nurses is needed. Patient-to-nurse ratio is an independent risk factor for nosocomial infections in intensive care, this must be kept in mind when planning rationalization of the number of nursing staff.

Community-onset candidemia at a university hospital, 1995-2005

BACKGROUND AND PURPOSE

Although not all candidemias are hospital-acquired, data on clinical epidemiology for the community-onset candidemia are limited. This retrospective study was conducted to describe predisposing factors and outcomes of community-onset candidemias.

METHODS

Medical records of patients who were admitted to the National Taiwan University Hospital between January 1, 1995 and May 31, 2005 and had Candida isolated from their blood in the outpatient setting and/or within 48 h of hospitalization (community-onset) were reviewed.

RESULTS

A total of 56 episodes of candidemia were reviewed, which included 8 episodes (14.3%) of true community-acquired candidemia occurring in patients with no record of hospitalization within the previous 30 days and without histories of invasive procedures either just before or at the time of admission, and 48 episodes (85.7%) that were health care-associated. The latter included 24 episodes (42.9%) in patients recently discharged from hospitals (within 2-30 days of current admission), 23 episodes (41.1%) associated with invasive procedures and/or central intravascular lines placed for outpatient therapy, and 1 episode (1.8%) in patients admitted from nursing homes. Gastrointestinal bleeding (46.4%), immunosuppressive therapy (42.9%) and previous antibiotics use (37.5%) were the most common predisposing factors. Diabetes was the single most important predisposing factor in true community-acquired candidemia (62.5%) and had a significantly higher prevalence among these patients than in those with health care-associated candidemias (p=0.035). Candida albicans was the most common isolate (39.7%), followed by Candida tropicalis (22.4%) and Candida glabrata (17.2%). The overall case fatality rate was 55.4% (31/56), and 58.1% (18/31) of this was attributable to candidemia. Multivariate analysis identified higher severity score and lack of antifungal therapy as having an independent and adverse influence on outcome.

CONCLUSIONS

Up to 85.7% of community-onset candidemias are health care-associated. There is a conceptual and practical need for a new classification for the spectrum of acquisition of infection, wherein the new category of health care-associated infection will have implications for the selection of empirical therapy.

Epidemiology of candidemia in a tertiary care centre of north India: 5-year study

BACKGROUND

To determine the distribution of species of Candida and the risk factors associated with candidemia in Indian population for which we conducted a retrospective study for 5 years in a tertiary care centre of North India.

MATERIALS AND METHODS

Blood samples from 7,297 patients aged from 3 days to 85 years, suspected with candidemia, were collected and tested for Candida. The susceptibility patterns toward fluconazole for the year 2005 isolates were tested by micro-dilution assay as described in the CLSI (M27A-2 method).

RESULTS

Most of the episodes have been caused by species other than C. albicans. Non-albicans candidemia was 79%-80% in both female and male populations. The most frequent species isolated from 275 patients in 5 years (January 2001-December 2005) was C. tropicalis (35.3%), followed by C. albicans (21.5%), C. parapsilosis (20%), C. glabrata (17.5%), C. krusei (3.3%), C. haemulonii (1.5%), and C. guilliermondii (1%). C. parapsilosis was the predominant in the fifth year of the study (2004-2005). Dose-dependent susceptibility to fluconazole was observed in 5% (n = 3) of the strains. Antifungal resistance was found in 11.7% (n = 7), which includes only C. glabrata.

CONCLUSION

These results were comparable to those derived from other regions of India. C. tropicalis has been reported as the predominant species involved in the cases of candidemia. But in 2005 it has moved toward C. parapsilosis. No true antifungal resistance is reported. Further epidemiological surveillance is needed.