Document Detail

Candidemia in Finland, 1995-1999.
Jump to Full Text
MedLine Citation:
PMID:  12967498     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We analyzed laboratory-based surveillance candidemia data from the National Infectious Disease Register in Finland and reviewed cases of candidemia from one tertiary-care hospital from 1995 to 1999. A total of 479 candidemia cases were reported to the Register. The annual incidence rose from 1.7 per 100,000 population in 1995 to 2.2 in 1999. Species other than Candida albicans accounted for 30% of cases without change in the proportion. A total of 79 cases of candidemia were identified at the hospital; the rate varied from 0.03 to 0.05 per 1,000 patient-days by year. Predisposing factors included indwelling catheters (81%), gastrointestinal surgery (27%), hematologic malignancy (25%), other types of surgery (21%), and solid malignancies (20%). Crude 7-day and 30-day case-fatality ratios were 15% and 35%, respectively. The rate of candidemia increased in Finland but is still substantially lower than in the United States. No shift to non-C. albicans species could be detected.
Authors:
Eira Poikonen; Outi Lyytikäinen; Veli-Jukka Anttila; Petri Ruutu
Related Documents :
16410948 - Record linkage and capture-recapture estimates for underreporting of human leptospirosi...
15883818 - Occupational hand-arm vibration syndrome in korea.
17119748 - Phlebotominae sand flies associated with a tegumentary leishmaniasis outbreak, tucumán...
1940328 - Schistosomiasis in cross river state, nigeria: 1. prevalence and intensity of infection...
223518 - Granular cell tumors of biliary ducts. report of two cases and review of the literature.
17967648 - Cricopharyngeal electromyography: patterns of injury based on etiology.
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Emerging infectious diseases     Volume:  9     ISSN:  1080-6040     ISO Abbreviation:  Emerging Infect. Dis.     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-09-11     Completed Date:  2003-11-05     Revised Date:  2011-07-20    
Medline Journal Info:
Nlm Unique ID:  9508155     Medline TA:  Emerg Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  985-90     Citation Subset:  IM    
Affiliation:
Peijas Hospital, Vantaa, Finland. eira.poikonen@hus.fi
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Candidiasis / epidemiology*,  etiology
Child
Child, Preschool
Cross Infection / epidemiology*,  etiology
Female
Finland / epidemiology
Humans
Incidence
Infant
Male
Middle Aged
Population Surveillance*
Registries
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): Emerg Infect Dis
Journal ID (publisher-id): EID
ISSN: 1080-6040
ISSN: 1080-6059
Publisher: Centers for Disease Control and Prevention
Article Information
Download PDF

Print publication date: Month: 8 Year: 2003
Volume: 9 Issue: 8
First Page: 985 Last Page: 990
ID: 3020607
PubMed Id: 12967498
Publisher Id: 03-0069
DOI: 10.3201/eid0908.030069

Candidemia in Finland, 1995–1999
Eira Poikonen*
Outi Lyytikäinen
Veli-Jukka Anttila
Petri Ruutu
*Peijas Hospital, Vantaa, Finland
National Public Health Institute, Helsinki, Finland
Helsinki University Central Hospital, Helsinki, Finland
Correspondence: Address for correspondence: Eira Poikonen, Peijas Hospital, Department of Medicine, Sairaalakatu 1, 01400 Vantaa, Finland; fax: +358-9-471 67 579; email: eira.poikonen@hus.fi

A number of reports indicate a substantial increase in candida infections in the United States during the last 2 decades, including a consequent rise in related deaths and prolonged hospitalization (15). Candida sp. have been shown to be the fourth most common group of organisms causing nosocomial bloodstream infections (BSI) in the United States (69). Reports also suggest an increase in candidemia in Europe and Australia (1012). Factors contributing to this trend are a growing population of immunocompromised patients and the use of new, aggressive, and invasive therapeutic strategies (6,13). Although most candidemia cases are due to Candida albicans, infections caused by non–C. albicans species have become more common (8,9,12,1418).

For the most part, the epidemiology of candidemia has been studied in selected hospitals, which may not be representative of all hospitals serving a population (11,12,1924). Few population-based studies identifying trends in the incidence of candidemia over time have been published, and the absolute numbers for age- and sex-specific incidence rates have rarely been reported (18,2528).

We evaluated trends in the incidence of BSIs caused by Candida spp. in Finland from 1995 to 1999, using data on BSIs from laboratory-based surveillance introduced in 1995. We also reviewed the characteristics of candidemia cases that occurred in the largest tertiary-care hospital in Finland during the same period.


Methods
Surveillance and Population

Finland (population 5.2 million) has five tertiary-care hospitals, with well-defined catchment populations of 0.71 to 1.66 million. Since 1995, all clinical microbiology laboratories in Finland have reported all bacterial and fungal isolations from blood, including Candida spp., to the National Infectious Diseases Register. Detection and species determination of Candida isolates are performed in the notifying laboratories according to standard protocols in use in each laboratory. Data collected with each notification include the date of isolation, date of birth, sex, type of specimen, and place of treatment.

A case of candidemia was defined as a patient with at least one blood culture positive for Candida species. Notifications of the same species of Candida within 3 months after the first diagnostic sample in the same patient were defined as one case. Isolations of the same species beyond this time period in the same patient were defined as separate cases.

Tertiary-Care Hospital

Helsinki University Central Hospital (HUCH) is a tertiary-care hospital with 1,600 beds that serves a population of 1.66 million living in the Helsinki area in southern Finland. In some specialties, such as bone marrow and solid organ transplantation, HUCH provides national service. All patients with at least one blood culture positive for Candida from January 1995 to December 1999 were retrospectively identified from the microbiology laboratory logbooks of HUCH’s department of bacteriology. Nosocomial versus community acquisition was defined according to proposed standard criteria (29). The following data were abstracted from patient charts: type of specialty, underlying conditions, central venous catheters and bladder catheters in place, cultures taken from these catheters, and the outcome of the illness. Immunosuppressive status was defined as cytotoxic therapy or total body irradiation <3 months before onset of candidemia or systemic cortisone (>40 mg per day at onset of cortisone treatment) <1 month before onset of candidemia. The annual numbers of patient days and discharges were acquired from the hospital administration. No guidelines for systematic antifungal prophylaxis for any patient groups were in use in HUCH during the study period.

Incidence Rates and Statistical Analysis

Data from the Finland National Population Registry from 1995 to 1999 were used as denominators to calculate age- and sex-specific incidence rates. Average annual incidences during the surveillance period were calculated by using the total number of cases and population during 1995 to 1999. To evaluate secular trends, rates of candidemia in different age and sex groups were calculated for each 6-month period from January 1995 to December 1999. If changes were detected, Poisson regression model was used to assess whether the observed changes in the rates were statistically significant.

Data were analyzed by using Epi Info version 6.04 (available from: URL: http://www.cdc.gov/epiinfo/ei6.htm) and SPSS for Windows version 11 (Chicago, IL). Categorical variables were analyzed with the chi-square test, Yates’s correction, or Fisher exact test, as appropriate. Continuous variables were analyzed by Student t test or the Mann-Whitney U test, depending on the sample distribution.


Results

A total of 479 candidemia cases were reported to the National Infectious Diseases Register from 1995 to 1999. The median age of the patients was 59 years of age (range 0–89 years); 266 (60%) were males. The average annual incidence of candidemia was 1.9 per 100,000 population and varied from 1.3 to 2.2 in the five tertiary-care hospital catchment areas. The incidence increased from 1.7 per 100,000 population in 1995 to 2.2 in 1999. The average annual incidence of candidemia was highest in infants <1 year of age and lowest in patients 1–15 years of age (Table 1); infants <1 year of age accounted for only 6% of all candidemia cases. In all age groups, the incidence was higher in males than in females. In males 16–65 years of age, the incidence rose significantly, from 1.0 per 100,000 population in 1995 to 2.4 per 100,000 population in 1999 (p<0.05 by Poisson regression); by 1999, the incidence rate for males was three times the rate in females. No trends were identified in other age and sex groups. The highest annual incidence (24.4/100,000 population) occurred in 1999 in infants <1 year of age, which was primarily caused by C. albicans (11 cases, 5 of which occurred in one tertiary-care hospital).

The most frequent Candida sp. encountered was C. albicans, which caused 335 (70%) cases (Table 2). The most common non–C. albicans species found was C. glabrata, followed by C. krusei, C. parapsilosis, and C. tropicalis. The other species reported were C. pelliculosa (five cases) and C. rugosa (one case). In 14 (3%) cases, the species were not specified. The proportion of non–C. albicans species did not increase during the study period.

In the study hospital, we identified a total of 86 candidemia cases. All but one case were determined to be nosocomial. Four of the 85 nosocomial candidemia case-patients were associated with predisposing treatment in other hospitals, and 2 additional cases-patients, for whom the clinical information was not available, were excluded, leaving 79 patients with cases of nosocomial candidemia for detailed analysis. The median duration of hospital stay before onset of candidemia was 19 days (range 0–177 days). The median age of the patients was 56 years (range <89 years); 45 (57%) of the patients were male.

The average annual incidence of candidemia at HUCH was 0.17 per 1,000 discharges (range by year 0.12–0.21) and 0.04 per 1,000 patient days (range by year 0.03–0.05). Male patients accounted for 70% of cases <1 year of age and 66% of those 16–65 years of age, whereas 64% of the cases >65 years of age were women. We found no increase in the annual number of cases in men 16–65 years of age, in contrast to the increasing rate identified in the national population-based analysis.

At the onset of candidemia, all cases in the study hospital had at least one predisposing factor. Of 79 cases, 19% were leukopenic (leukocytes <1 x 10E9/L), and 14% were neutropenic (neutrophils <0.5 x 10E9/L); 44% were immunocompromised. Gastrointestinal surgery was the most common underlying condition, followed by hematologic malignancy, other surgery, and solid malignancies (Table 3). Solid organ transplantation preceded onset of candidemia in three cases and bone marrow transplantation in five. None of the case-patients had HIV infection. At the onset of candidemia, 18 cases (23%) were treated in intensive-care units (ICU). Nine (50%) of 18 ICU cases were treated in neonatal ICUs. These 9 neonatal ICU case-patients were preterm and constituted 90% of infants <1 year of age; mean gestational age was 28 weeks (range 23–39), and mean birth weight 1,129 g (range 450–3,340 g). Before onset of candidemia, 64 (81%) of case-patients had a central venous catheter and 33 (42%) had a bladder catheter in place. Central venous catheter tip culture was positive for Candida in 28 (44%) of the 64 cases, and urine culture was positive for Candida in 7 (21%) of the 33 patients with a bladder catheter. Biopsy-proven deep Candida infection was detected in 9 cases (11%); all had central venous catheters, and 8 (89%) were operated before onset of candidemia.

The most common Candida species at HUCH was C. albicans (55 cases, 70%), consistent with the overall national figure (Table 2). For non–C.albicans species, the proportion varied by year from 17% in 1997 to 37% in 1999. In contrast to the national data, C. parapsilosis was as common as C. glabrata at the study hospital (six cases each).

Among the 79 patients with candidemia at HUCH, 12 (15%) died within 1 week after onset and 28 (35%) within 1 month. Of those who died, one patient had had preceding treatment in ICU. The patients who died were significantly older (median age 51 vs. 60 years of age, p<0.05) and were more likely to have hematologic malignancies (60% vs. 27%, p<0.05).


Discussion

Our nationwide population-based study shows that the incidence of candidemia in Finland is relatively low. However, we found a consistent year-to-year increase, mainly attributable to an increase in the incidence among men 16–65 years of age. No shift towards non–C. albicans species was observed.

We analyzed laboratory-based surveillance data on BSIs caused by Candida spp. from nationwide surveillance; therefore, our estimates are representative of the whole population. The rate we found is one third to one fourth of the rates reported from the United States (6.0–8.0/100,000 population) (18,25,26). Two of the U.S. reports included selected urban areas, and the third one was based on sentinel surveillance implemented in selected laboratories in Iowa (which may not be representative of the general U.S. population). A nationwide study from Iceland also documented an increase in the incidence of candidemia from 1.4 per 100,000 population in 1980 to 1984 to 4.9 in 1995 to 1999 (27). The 1995–1999 rate in Iceland was more than twice as high as the rate we observed in Finland during the same period. Another nationwide study from Norway reporting the annual numbers of fungemia cases did not identify any change in the period 1991–1996 (28). This study also included non-Candida yeasts. We did not identify any shift towards non–C. albicans species, in contrast to several reports from the United States, Australia, and Europe (12,14,16,18) but in accordance with the nationwide studies from Iceland and Norway (27,28).

We observed the highest age-specific incidence rate in infants <1 year of age. This rate is, however, substantially lower than the rates reported from the Atlanta and San Francisco Bay areas in 1992 and 1993 in the same age group (9.4 vs. 75/100,000 population) (18). We found a substantial increase in candidemia cases in men 16–65 years of age. The reason for this increase remains unknown; the detailed analysis in the largest tertiary-care hospital in Finland during the same period showed no increase or major change of characteristics in this demographic subgroup. The Icelandic study showed that the incidence was highest in the elderly and that the increase occurred most in the youngest age group (27). The male dominance we observed is similar to that found in previous reports (18,25,26,28).

At the largest tertiary-care hospital in Finland, the average annual incidence of candidemia per 1,000 patient days was considerably less than that in the United States (0.04 vs. 2.15), as was the rate per 1,000 discharges (0.17 vs. 0.6) (2,30). Incidences similar to the current study have been reported from European (11,2224,28) and Australian tertiary-care centers (12). We observed that non-nosocomial candidemia was very rare in this tertiary-care hospital (1/84 cases), which is in strong contrast to reports from the United States, where one fifth of candidemias developed in patients before or on admission to hospital (18).

Differences in candidemia rates between countries may also be attributable to differences in the representativeness of the study population, the prevalence of HIV infection in the study population, and variations in patterns of healthcare delivery and clinical practices, including the frequency of using blood cultures in diagnostics. The differences may also be explained by differences in antibiotic use patterns and resistance situation (28). A previous study from Finland on nosocomial BSIs showed that Candida spp. represented only 4% of all findings and the prevalence of antibiotic resistance among bacterial findings was lower than in the United States (31).

The role of fluconazole prophylaxis is well established in neutropenic patients; however, among patients without neutropenia, such as surgical ICU patients, this role is less definitive (3234). Clinical practices in prophylaxis policies may vary a great deal between institutions and countries. While the prophylaxis effectively reduces the incidence of infections caused by fluconazole-sensitive species, the drug has an impact on the distribution of causative Candida species (11,15,3235). Although national data on fluconazole usage are available from Iceland and Norway, they are not comparable (27,28).

Our study confirms the importance of surgery, cancer, and hematologic malignancies as factors contributing to nosocomial candidemia. Only 23% of our candidemia patients were being treated in ICUs. Approximately twice the proportion of patients with candidemia who had had preceding treatment in ICU was reported from Italy (21,24), but a similar proportion to ours was reported from France (23). Our patient population included no HIV patients, which reflects the low prevalence of HIV infection in Finland (10–16/100,000 population in 1995–1999) (36). This low prevalence may substantially contribute to both the lower overall incidence of candidemia and the low proportion of non-nosocomial Candida infection in Finland, since in the United States the proportion of candidemia cases with HIV infection to all candidemia cases varied from 10% to 15% (18,25). The contribution of HIV infection as a predisposing risk factor for candidemia is further emphasized by a report from Italy, where Candida spp. was the third most common cause of nosocomial BSI in HIV patients (37). In France, among cases of nosocomial candidemia, 13% of patients were reported to have HIV infection during 1990–1995 in one institution (38).

The high case-fatality ratio we observed in the older age groups and in patients with a hematologic malignancy reflects the combination of serious underlying diseases and the intensity of treatments modifying host defense that leads to candidemia. In our study, the overall case-fatality ratio of 15% during 1 week and 35% within 1 month after the onset of candidemia are similar to ratios reported from Europe (21,24) and the United States (39), with case-fatality ratios ranging from 35% to 39%, respectively, within 1 month after onset of candidemia.

The results of this study demonstrate a low but consistently increasing incidence of candidemia in Finland. The high case-fatality ratio emphasizes the need for continuous surveillance to identify changes in predisposing factors for optimizing prevention policies, including the use of antifungal prophylaxis.


Notes

Suggested citation for this article: Poikonen E, Lyytikäinen O, Anttila V-J, Ruutu P. Candidemia in Finland, 1995–1999. Emerg Infect Dis [serial online] 2003 Aug [date cited]. Available from: URL: http://www.cdc.gov/ncidod/EID/vol9no8/03-0069.htm

Dr. Poikonen is a clinical hematologist at Peijas Hospital, Vantaa, Finland. Her research interests include invasive candida infections and candidemias and the risk factors and outcome of these infections, specifically the epidemiology of invasive candida infections.


References
1. . HarveyRL, MyersJPNosocomial fungemia in a large community teaching hospital.Arch Intern Med. Year: 1987;147:2117–2010.1001/archinte.147.12.21173689063
2. . PittetD, WenzelRPNosocomial bloodstream infections.Arch Intern Med. Year: 1995;155:1177–8410.1001/archinte.155.11.11777763123
3. . Fisher-HochSP, HutwagnerLOpportunistic candidiasis: an epidemic of the 1980s.Clin Infect Dis. Year: 1995;21:897–9048645837
4. . KossoffEH, BuescherES, KarlowiczMGCandidemia in a neonatal intensive care unit: trends during fifteen years and clinical features of 111 cases.Pediatr Infect Dis J. Year: 1998;17:504–810.1097/00006454-199806000-000149655543
5. . WeySB, MoriM, PfallerMA, WoolsonRF, WenzelRPHospital-acquired candidemia.Arch Intern Med. Year: 1988;148:2642–510.1001/archinte.148.12.26423196127
6. . Beck-SaguéCM, JarvisWRthe National Nosocomial Infections Surveillance System. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980–1990.J Infect Dis. Year: 1993;167:1247–518486965
7. . JarvisWREpidemiology of nosocomial fungal infections, with emphasis on candida species.Clin Infect Dis. Year: 1995;20:1526–307548503
8. . PfallerMA, JonesRN, MesserSA, EdmondMB, WenzelRPNational surveillance of nosocomial bloodstream infection due to Candida albicans: frequency of occurrence and antifungal susceptibility in the SCOPE program.Diagn Microbiol Infect Dis. Year: 1998;31:327–3210.1016/S0732-8893(97)00240-X9597393
9. . EdmondMB, WallaceSE, McClishDK, PfallerMA, JonesRN, WenzelRPNosocomial bloodstream infections in United States hospitals: a three-year analysis.Clin Infect Dis. Year: 1999;29:239–4410.1086/52019210476719
10. . VincentJ-L, BihariDJ, SuterPM, BruiningHA, WhiteJ, Nicolas-ChanoinM-H, et al. The prevalence of nosocomial infection in intensive care units in Europe.JAMA. Year: 1995;274:639–4410.1001/jama.274.8.6397637145
11. . VossA, KluytmansJAJW, KoelemanJGM, SpanjaardL, Vandenbroucke-GraulsCMJE, VerbrughHA, et al. Occurrence of yeast bloodstream infections between 1987 and 1995 in five Dutch university hospitals.Eur J Clin Microbiol Infect Dis. Year: 1996;15:909–1210.1007/BF016905079031872
12. . HopeW, MortonA, EisenDPIncrease in prevalence of nosocomial non–Candida albicans candidaemia and the association of Candida krusei with fluconazole use.J Hosp Infect. Year: 2002;50:56–6510.1053/jhin.2001.113111825053
13. . FridkinSK, JarvisWREpidemiology of nosocomial fungal infections.Clin Microbiol Rev. Year: 1996;9:499–5118894349
14. . Borg-von ZeppelinM, EiffertH, KannM, RüchelRChanges in the spectrum of fungal isolates: results from clinical specimens gathered in 1987/88 compared with those in 1991/92 in the university of Göttingen, Germany.Mycoses. Year: 1993;36:247–5310.1111/j.1439-0507.1993.tb00759.x8114803
15. . NguyenMH, PeacockJE, MorrisAJ, TannerDC, NguyenML, SnydmanDR, et al. The changing face of candidemia: emergence of non-Candida albicans species and antifungal resistance.Am J Med. Year: 1996;100:617–2310.1016/S0002-9343(95)00010-08678081
16. . Abi-SaidD, AnaissieE, UzunO, RaadI, PinzcowskiH, VartivarianSThe epidemiology of hematogenous candidiasis caused by different Candida species.Clin Infect Dis. Year: 1997;24:1122–810.1086/5136639195068
17. . PfallerMA, JonesRN, DoernGV, FluitAC, VerhoefJ, SaderHS, et al. International surveillance of bloodstream infections due to Candida species in the European SENTRY program: species distribution and antifungal susceptibility including the investigational triazole and echinocandin agents.Diagn Microbiol Infect Dis. Year: 1999;35:19–2510.1016/S0732-8893(99)00046-210529877
18. . KaoAS, BrandtME, PruittWR, ConnLA, PerkinsBS, StephensDS, et al. The epidemiology of candidemia in two United States cities: results of a population-based active surveillance.Clin Infect Dis. Year: 1999;29:1164–7010.1086/31345010524958
19. . PetriMG, KönigJ, MoeckeHP, GrammHJ, BarkowH, KujathP, et al. Epidemiology of invasive mycosis in ICU patients: a prospective multicenter study in 435 non-neutropenic patients.Intensive Care Med. Year: 1997;23:317–2510.1007/s0013400503349083235
20. . PittetD, HarbarthS, RuefC, FrancioliP, SudreP, PétignatC, et al. Prevalence and risk factors for nosocomial infections in four university hospitals in Switzerland.Infect Control Hosp Epidemiol. Year: 1999;20:37–4210.1086/5015549927264
21. . ViscoliC, GirmeniaC, MarinusA, ColletteL, MartinoP, VandercamB, et al. Candidemia in cancer patients: a prospective multicenter surveillance study by the Invasive Fungal Infection Group (IFIG) of the European Organization for Research and Treatment of Cancer (EORTC).Clin Infect Dis. Year: 1999;28:1071–910.1086/51473110452637
22. . LuzzatiR, AmalfitanoG, LazzariniL, SoldaniF, BellinoS, SolbiatiM, et al. Nosocomial candidemia in non-neutropenic patients at an Italian tertiary care hospital.Eur J Clin Microbiol Infect Dis. Year: 2000;19:602–710.1007/s10096000032511014622
23. . RichetH, RouxP, Des ChampsC, EsnaultY, AndremontAthe French Candidemia Study Group. Candidemia in French hospitals: incidence rates and characteristics.Clin Microbiol Infect. Year: 2002;8:405–1210.1046/j.1469-0691.2002.00446.x12199850
24. . TortoranoAM, BiraghiE, AstolfiA, OssiC, TejadaM, FarinaC, et al. European Confederation of Medical Mycology (ECMM) prospective survey of candidaemia: report from one Italian region.J Hosp Infect. Year: 2002;51:297–30410.1053/jhin.2002.126112183145
25. . ReesJR, PinnerRW, HajjehRA, BrandtME, ReingoldALThe epidemiological features of invasive mycotic infections in the San Francisco Bay area, 1992–1993: results of population-based laboratory active surveillance.Clin Infect Dis. Year: 1998;27:1138–4710.1086/5149759827260
26. . DiekemaDJ, MesserSA, BrueggemansAB, CoffmanSL, DoernGV, HerwaldtLA, et al. Epidemiology of candidemia: 3-year results from the emerging infections and the epidemiology of Iowa organisms study.J Clin Microbiol. Year: 2002;40:1298–30210.1128/JCM.40.4.1298-1302.200211923348
27. . ÁsmundsdóttirLR, ErlensdóttirH, GottfredssonMIncreasing incidence of candidemia: results from a 20-year nationwide study in Iceland.J Clin Microbiol. Year: 2002;40:3489–9210.1128/JCM.40.9.3489-3492.200212202600
28. . SandvenP, BevangerL, DigranesA, GaustadP, HauklandHH, SteinbakkM, et al. Constant low rate of fungemia in Norway, 1991 to 1996.J Clin Microbiol. Year: 1998;36:3455–99817853
29. . GarnerJS, JarvisWR, EmoriTG, HoranTC, HughesJMCDC definitions for nosocomial infections.Am J Infect Control. Year: 1988;16:128–4010.1016/0196-6553(88)90053-32841893
30. . BanerjeeSN, EmoriTG, CulverDH, GaynesRP, JarvisWJR, HoranT, et al. Secular trends in nosocomial primary bloodstream infections in the United States, 1980–1989.Am J Med. Year: 1991;91(Suppl):86S–9S10.1016/0002-9343(91)90349-31928197
31. . LyytikäinenO, LumioJ, SarkkinenH, KolhoE, KostialaA, RuutuPNosocomial bloodstream infections in Finnish hospitals during 1999–2000.Clin Infect Dis. Year: 2002;35:e14–910.1086/34098112087538
32. . SlavinMA, OsborneB, AdamsR, LevensteinMJ, SchochHG, FeldmanAR, et al. Efficacy and safety of fluconazole prophylaxis for fungal infections after marrow transplantation—a prospective, randomized, double-blind study.J Infect Dis. Year: 1995;171:1545–527769290
33. . BlumbergHM, JarvisWR, SoucieJM, EdwardsJM, PattersonJE, PfallerMA, et al. Risk factors for candidal bloodstream infections in surgical intensive care unit patients: the NEMIS prospective multicenter study.Clin Infect Dis. Year: 2001;33:177–8610.1086/32181111418877
34. . SinghNTrends in the epidemiology of opportunistic fungal infections: predisposing factors and the impact of antimicrobial use practices.Clin Infect Dis. Year: 2001;33:1692–610.1086/32389511641825
35. . WingardJR, MerzWG, RinaldiMG, JohnsonTR, KarpJE, SaralRIncrease in Candida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole.N Engl J Med. Year: 1991;325:1274–710.1056/NEJM1991103132518031669837
36. . National Public Health Institute Infectious diseases in Finland 2000. Publications of the National Health Institute. Year: 2001 [Cited 22 November 2002.] Available from: URL: http://www.ktl.fi/en/publications
37. . PetrosilloN, VialeP, NicastriE, AriciC, BombanaE, CaellaA, et al. Nosocomial bloodstream infections among human immunodeficiency virus-infected patients: incidence and risk factors.Clin Infect Dis. Year: 2002;34:677–8510.1086/33881311823956
38. . LaunayO, LortholaryO, Bouges-MichelC, JarrousseB, BentataM, GuillevinLCandidemia: a nosocomial complication in adults with late-stage AIDS.Clin Infect Dis. Year: 1998;26:1134–4210.1086/5202919597242
39. . PittetD, LiN, WoolsonRF, WenzelRPMicrobiological factors influencing the outcome of nosocomial bloodstream infections: a 6-year validated, population-based study.Clin Infect Dis. Year: 1997;24:1068–7810.1086/5136409195059

Tables
[TableWrap ID: T1] Table 1  Annual incidence of candidemia by sex and age group, Finland, 1995–1999
Characteristics Ratea
1995 1996 1997 1998 1999 1995–1999
Males (y)
<1
12.5
10.0
3.3
6.9
27.3
11.9 (18)
1–15
1.2
0.4
0.6
0
0.2
0.5 (12)
16–65
1.0
1.9
1.9
2.1
2.4
1.8 (159)
>65
7.7
6.3
6.1
9.4
7.7
7.4 (97)
All
1.9 (46)
2.1 (53)
2.1 (53)
2.5 (63)
2.8 (71)
2.3 (286)
Females (y)
<1
6.5
3.4
0
3.6
21.3
6.9 (10)
1–15
0.6
0.4
0.6
0.2
0.6
0.5 (12)
16–65
1.0
0.8
1.1
1.2
0.8
1.0 (84)
>65
4.2
4.3
3.4
3.6
4.2
3.9 (87)
All
1.5 (39)
1.4 (36)
1.4 (37)
1.5 (39)
1.6 (42)
1.5 (193)
All (y)
<1
9.6
6.6
1.7
5.3
24.4
9.4 (28)
1–15
1.0
0.5
0.6
0.1
0.4
0.5 (24)
16–65
1.0
1.4
1.5
1.7
1.6
1.4 (243)
>65
5.4
5.0
4.4
5.7
5.6
5.2 (184)
All 1.7 (85) 1.7 (89) 1.8 (90) 2.0 (102) 2.2 (113) 1.9 (479)

aCases per 100,000 population (no. of cases).


[TableWrap ID: T2] Table 2  Distribution of Candida spp. causing bloodstream infections, Finland, 1995–1999a
Candida species 1995 1996 1997 1998 1999 1995–1999
C. albicans
67
(57)
75
(67)
73
(66)
61
(62)
73
(83)
70
(335)
Non-C. albicans
33
(28)
25
(22)
27
(24)
39
(40)
27
(30)
30
(144)
C. glabrata
14
(12)
3
(3)
8
(7)
8
(8)
10
(11)
9
(41)
C. krusei
5
(4)
12
(10)
4
(4)
15
(16)
5
(6)
8
(40)
C. parapsilosis
11
(9)
1
(1)
6
(5)
6
(6)
5
(6)
5
(27)
C. tropicalis
1
(1)
3
(3)
1
(1)
5
(5)
3
(3)
3
(13)
Other 2 (2) 6 (5) 8 (7) 5 (5) 4 (4) 5 (23)

aPercent (no.).


[TableWrap ID: T3] Table 3  Predisposing factors among 79 patients with nosocomial candidemia, Helsinki University Central Hospital, 1995–1999a
Predisposing factor No. (%)
Central venous catheter
64
(81)
Urinary catheter
33
(42)
Gastrointestinal surgeryb
22
(27)
Hematologic malignancy
20
(25)
Other surgerya
17
(21)
Solid malignancy
16
(20)
Diabetes
14
(18)
Newborn status
9
(11)
Organ transplantation
8
(10)
Severe trauma 2 (3)

aOne patient may have several predisposing factors.

bSurgery during the same hospital period as candidemia, or within 1 month before the first blood culture.



Article Categories:
  • Research


Previous Document:  Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin ...
Next Document:  Severe acute respiratory syndrome: temporal stability and geographic variation in case-fatality rate...