Epidemiology of candidemia in an university hospital: therapeutic incidence.

Twenty-two candidemia happened in our hospital from January 1997 to may 199 8. We studied the clinical evolution of the patients and the sensitivity of the yeasts to antifungal therapy (Fungitest and E-Test method). We found 1 1 Candida albicans (CA), 10 Candida non albicans (CNA) (3 C. glabrata, 2 C. parapsilosis, 4 C. tropicalis, 1 C. krusei) and 1 Saccharomyces cerevisiae . The mean age of the patients was 56,4 years. There were 13 men and 9 wome n. We found one group of 8 (36.4%) oncohematological patients, one group of 8 (36.4%) patients with abdominal surgery, one group of 3 (13.6%) children and one group of 3 adults (13.6%) who spent more than 10 days in an intens ive care unit. Ten times, these candidemia were associated with bacteriemia , 4 times with several bacteria. Three patients died because of the candide mia, 2 times with CNA and one time with CA. There wasn't any resistance to amphotericin B or ketoconazole. All the CA and 3 CNA (30%) remained sensiti ve to the four antifungal drugs we used (amphotericin B, ketoconazole, fluc onazole, itraconazole). The 3 C. glabrata and the C. krusei were resistant or limit to fluconazole. Since the generalization of the use of fluconazole , the epidemiology is marked by the emergence of new strains of CA with hig h level of resistance to azols, and of CNA. In our hospital, the CA remain preponderant and only the CNA are resistant to fluconazole making difficult the choice of empiric treatment for serious fungemia.