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    Candidaemia in an Irish tertiary referral hospital: epidemiology and prognostic factors.

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    Authors
    Boo, T W
    O'reilly, B
    O'leary, J
    Cryan, B
    Affiliation
    Department of Microbiology, Cork University Hospital, Cork, Ireland., twboo@eircom.net
    Issue Date
    2012-02-03T15:06:59Z
    MeSH
    Adolescent
    Adult
    Aged
    Blood/microbiology
    Candida/classification/isolation & purification
    Candidiasis/*epidemiology/microbiology
    Catheterization
    Child
    Child, Preschool
    Cross Infection/*epidemiology/microbiology
    Female
    Fungemia/*epidemiology/microbiology
    Humans
    Incidence
    Infant
    Infant, Newborn
    Ireland/epidemiology
    Male
    Middle Aged
    Prognosis
    Retrospective Studies
    Risk Factors
    Urinary Tract Infections/microbiology
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    Citation
    Mycoses. 2005 Jul;48(4):251-9.
    Journal
    Mycoses
    URI
    http://hdl.handle.net/10147/208904
    DOI
    10.1111/j.1439-0507.2005.01134.x
    PubMed ID
    15982207
    Abstract
    There were two parts to this study. Part 1 evaluated the epidemiology of Candida bloodstream isolates within the Southern Health Board (SHB) of Ireland from 1992 to 2003 by retrospective surveillance of all such isolates of patients reported from SHB hospitals to our laboratory database during that period. Part 2 reviewed candidaemia cases occurring in Cork University Hospital (CUH) from 1999 to 2003 using surveillance of all positive blood culture isolates in CUH microbiology laboratory during the 5-year period. In part 1, 250 Candida bloodstream isolates were reported in the SHB over 12 years. There was a pattern of decreasing percentage of C. albicans with time. Whereas in part 2, 63 cases of candidaemia were identified in CUH from 1999 to 2003. Candida albicans constituted 50% of all isolates, while C. parapsilosis and C. glabrata accounted for 21.2% and 18.2% respectively. Average annual incidence rate was 0.48 episodes/1000 admissions and 0.70 episodes/10 000 patient-days. Vascular catheters were the commonest source of candidaemia (61.9%) followed by the urinary tract (12.7%). Risk factors included exposure to multiple antibiotics (75%); central vascular catheterization (73%); multiple colonization sites (71%); severe gastrointestinal (GI) dysfunction (54%) and acute renal failure (43%). Crude 7-day and 30-day mortality rates were 20.6% and 39.7% respectively. Logistic regression multivariate analysis identified the following to be independent predictors for mortality: age > or =65 years [odds ratio (OR) 7.2, P = 0.013]; severe GI dysfunction (OR 10.6, P = 0.01); acute renal failure (OR 7.6, P = 0.022); recent/concurrent bacteraemia (OR 5.2, P = 0.042); endotracheal intubation (OR 7.7, P = 0.014); while major surgery was associated with a better prognosis (OR 0.05, P = 0.002). Appropriate antifungal treatment was also found to be associated with survival (Fisher's exact test, P < 0.001). The epidemiology of Candida bloodstream isolates within our health board had changed over the years. Incidence and mortality of candidaemia were relatively high in our hospital. Dysfunction of major organ systems and recent bacteraemia were found to predict mortality.
    Language
    eng
    ISSN
    0933-7407 (Print)
    0933-7407 (Linking)
    ae974a485f413a2113503eed53cd6c53
    10.1111/j.1439-0507.2005.01134.x
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    Cork University Hospital

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