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 be cause of the growing population of immunocompromised patients who undergo a gressive diagnostic and therapeutic techniques. OBJECTIVE. To know the epidemiologic characteristics, risk factors, clinica l features and prognosis of fungemia. PATIENTS AND METHODS. We prospectively evaluated all the patients with prov en fungemia in our center during a 5 year-period. After finishing antifunga l treatment a minimun follow-up of 1 month was carried out. Fungal isolatio n and identification were performed by standard tests. RESULTS. During the period of study we evaluated 81 patients with an episod e of nosocomial fungemia. Global incidence was 0,9 episodes per thousand ad mitted patients. Candida albicans was the more frequently isolated species (n=53), followed by C. parapsilosis (n=11), C. tropicalis (n=6) and C. glab rata (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 p rocedures during present admission, leucocytosis, shock, and delay in antif ungal treatment. CONCLUSIONS. Fungal bloodstream infection incidence is high in our environm ent. It is associated with a high mortality rate, specially in patients in whom the beginning of antifungal treatment was delayed. A higher clinical s uspicion index may improve the poor outcome in these patients.