DALLAS The incidence of invasive candidiasis is more than 50% greater in academic medical centers than in community hospitals, although the distribution of Candida species is similar in both settings, according to the national Candida Surveillance Study.
During the survey period of 2004-2006, most cases in both academic and community hospitals were caused by species other than C. albicans, most commonly C. glabrata, which accounted for almost 25% of all cases of invasive candidiasis nationally, Patricia Hoover reported at the annual meeting of the Society of Hospital Medicine.
This 1-in-4 proportion of invasive candidiasis caused by C. glabrata is of clinical relevance because this organism is less susceptible to fluconazole than is C. albicans or other Candida species, according to Ms. Hoover of Merck & Co., which sponsored the national study.
Two independent risk factors for invasive C. glabrata infection emerged from the study. The incidence was 46% greater in women than in men, and the infection was 25% more common in patients aged 18 or older than in those younger than 18.
Based on these findings, it's advisable for physicians who treat primarily adults and/or practice at an institution with a high C. glabrata rate to consider using an antifungal agent other than fluconazole for empiric therapy until the lab identifies the specific causative Candida species, she continued.
The Candida Surveillance Study involved 33 nationally representative academic and 8 community hospitals that collectively contributed 3,503 isolates from patients with invasive candidiasis for species identification at a core lab.
The annualized incidence of invasive candidiasis in community hospitals was 11.5 cases/10,000 discharges, compared with 18.2 cases/10,000 discharges in the academic hospitals.
The prevalence of C. albicans in patients with invasive candidiasis who had received antifungal prophylaxis was 39.6%, compared with a 45.9% prevalence in those without prophylaxis. This represented a significant 14% relative risk reduction. Consideration should be given to this finding in selecting empiric antifungal therapy, she said.
A wide range of underlying diseases was present in patients who developed invasive candidiasis. GI disorders were the most common, being present in 7.5% of all cases, followed by diabetes, present in 6.4%, and solid organ malignancy in 6.0%. Recent abdominal surgery was deemed the trigger in 4.1% of all cases.
In the 1980s, C. albicans was the cause of most invasive candidiasis in the United States. That changed in the 1990s, as the proportion of invasive candidal infections caused by C. albicans decreased to about 45%, mainly because of a rise in C. glabrata infections.