Nosocomial fungemias in a general hospital.: Epidemiology and prognostic factors.: Prospective study 1993-1998

BACKGROUND. Nosocomial fungemias are infenctions with a high mortality rate. In last years the incidence of these infections has increased probably because of the growing population of immunocompromised patients who undergo agressive diagnostic and therapeutic techniques. OBJECTIVE. To know the epidemiologic characteristics, risk factors, clinical features and prognosis of fungemia. PATIENTS AND METHODS. We prospectively evaluated all the patients with proven fungemia in our center during a 5 year-period. After finishing antifungal treatment a minimun follow-up of 1 month was carried out. Fungal isolation and identification were performed by standard tests. RESULTS. During the period of study we evaluated 81 patients with an episode of nosocomial fungemia. Global incidence was 0,9 episodes per thousand admitted patients. Candida albicans was the more frequently isolated species (n=53), followed by C. parapsilosis (n=11), C. tropicalis (n=6) and C. glabrata (n=5). Most of the patients had a central intravenous line and were on parenteral nutrition therapy. All of them previously received at least one course of broad-spectrum antibiotics. Overall mortality was 49,6%. A worst prognosis was significantly associated with: age over 65 years, surgical procedures during present admission, leucocytosis, shock, and delay in antifungal treatment. CONCLUSIONS. Fungal bloodstream infection incidence is high in our environment. It is associated with a high mortality rate, specially in patients in whom the beginning of antifungal treatment was delayed. A higher clinical suspicion index may improve the poor outcome in these patients.