Skip to main content
PMC home page
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1999 Feb 23;160(4):493–499.

Candidemia at selected Canadian sites: results from the Fungal Disease Registry, 1992-1994

D L Yamamura 1, C Rotstein 1, L E Nicolle 1, S Ioannou 1
PMCID: PMC1230074  PMID: 10081465

Abstract

BACKGROUND: Candida species are important bloodstream pathogens that are being isolated with increasing frequency. Despite the availability of effective antifungal therapy, the mortality rate associated with Candida infection remains high. With the objective of describing the epidemiology of candidemia, the Canadian Infectious Disease Society conducted a study of candidemia in Canada. METHODS: Fourteen medical centres across Canada identified all patients with candidemia from March 1992 to February 1994 through blood culture surveillance for Candida spp. Patient-related data for invasive fungal infection were compiled retrospectively by chart review using a standardized data-recording form developed for the Fungal Disease Registry of the Canadian Infectious Disease Society. Cases of Candidemia were studied in relation to underlying medical conditions, predisposing factors, concurrent infection, antimicrobial agents, antifungal treatment and deaths. RESULTS: In total, 415 cases of candidemia were identified, 48 (11.6%) in children and 367 (88.4%) in adults. The causative pathogens were C. albicans in 286 cases (68.9%), C. parapsilosis in 43 (10.4%), C. glabrata in 34 (8.2%), C. tropicalis in 27 (6.5%) and other Candida species in 18 (4.3%); polymicrobial candidemia occurred in 7 cases (1.7%). The overall mortality rate was 46%, and the rate of deaths clinically related to candidemia was 19%. However, only 13 (27%) of the children died. A univariate analysis indicated that significant risk factors for death were age greater than 60 years, therapy for concomitant bacterial infection, stay in an intensive care unit, concurrent malignant disease, cytotoxic chemotherapy and granulocytopenia, although only age and stay in an intensive care unit emerged as significant risk factors in the multivariate analysis. After adjustment for other predictors of death, only infection with C. parapsilosis was associated with a lower mortality rate than infection with C. albicans. Treatment was given in 352 (84.8%) of cases. Amphotericin B was the preferred agent in 244 cases (69.3% of those treated); fluconazole was used in 101 cases (28.7%) and ketoconazole in 5 cases (1.4%). INTERPRETATION: Candidemia in Canada is caused predominantly by C. albicans. The mortality rate associated with candidemia is high, but it varies with the species of Candida and is lower in children than in adults. Age greater than 60 years and stay in an intensive care unit were the most significant risk factors for overall mortality.

Full Text

The Full Text of this article is available as a PDF (152.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Fraser V. J., Jones M., Dunkel J., Storfer S., Medoff G., Dunagan W. C. Candidemia in a tertiary care hospital: epidemiology, risk factors, and predictors of mortality. Clin Infect Dis. 1992 Sep;15(3):414–421. doi: 10.1093/clind/15.3.414. [DOI] [PubMed] [Google Scholar]
  2. Girmenia C., Martino P., De Bernardis F., Gentile G., Boccanera M., Monaco M., Antonucci G., Cassone A. Rising incidence of Candida parapsilosis fungemia in patients with hematologic malignancies: clinical aspects, predisposing factors, and differential pathogenicity of the causative strains. Clin Infect Dis. 1996 Sep;23(3):506–514. doi: 10.1093/clinids/23.3.506. [DOI] [PubMed] [Google Scholar]
  3. Guerra-Romero L., Telenti A., Thompson R. L., Roberts G. D. Polymicrobial fungemia: microbiology, clinical features, and significance. Rev Infect Dis. 1989 Mar-Apr;11(2):208–212. doi: 10.1093/clinids/11.2.208. [DOI] [PubMed] [Google Scholar]
  4. Jarvis W. R. Epidemiology of nosocomial fungal infections, with emphasis on Candida species. Clin Infect Dis. 1995 Jun;20(6):1526–1530. doi: 10.1093/clinids/20.6.1526. [DOI] [PubMed] [Google Scholar]
  5. Karabinis A., Hill C., Leclercq B., Tancrède C., Baume D., Andremont A. Risk factors for candidemia in cancer patients: a case-control study. J Clin Microbiol. 1988 Mar;26(3):429–432. doi: 10.1128/jcm.26.3.429-432.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Kataoka S., Kashiwa M., Saku K., Handa N., Akiyama H. Candidemia in non-neutropenic patients with an intravenous hyperalimentation catheter: good prognosis of Candida parapsilosis infection. Kansenshogaku Zasshi. 1995 Sep;69(9):969–974. doi: 10.11150/kansenshogakuzasshi1970.69.969. [DOI] [PubMed] [Google Scholar]
  7. Komshian S. V., Uwaydah A. K., Sobel J. D., Crane L. R. Fungemia caused by Candida species and Torulopsis glabrata in the hospitalized patient: frequency, characteristics, and evaluation of factors influencing outcome. Rev Infect Dis. 1989 May-Jun;11(3):379–390. doi: 10.1093/clinids/11.3.379. [DOI] [PubMed] [Google Scholar]
  8. Meunier F., Aoun M., Bitar N. Candidemia in immunocompromised patients. Clin Infect Dis. 1992 Mar;14 (Suppl 1):S120–S125. doi: 10.1093/clinids/14.supplement_1.s120. [DOI] [PubMed] [Google Scholar]
  9. Nguyen M. H., Peacock J. E., Jr, Morris A. J., Tanner D. C., Nguyen M. L., Snydman D. R., Wagener M. M., Rinaldi M. G., Yu V. L. The changing face of candidemia: emergence of non-Candida albicans species and antifungal resistance. Am J Med. 1996 Jun;100(6):617–623. doi: 10.1016/s0002-9343(95)00010-0. [DOI] [PubMed] [Google Scholar]
  10. Nguyen M. H., Peacock J. E., Jr, Tanner D. C., Morris A. J., Nguyen M. L., Snydman D. R., Wagener M. M., Yu V. L. Therapeutic approaches in patients with candidemia. Evaluation in a multicenter, prospective, observational study. Arch Intern Med. 1995 Dec 11;155(22):2429–2435. [PubMed] [Google Scholar]
  11. Rex J. H., Bennett J. E., Sugar A. M., Pappas P. G., van der Horst C. M., Edwards J. E., Washburn R. G., Scheld W. M., Karchmer A. W., Dine A. P. A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia. Candidemia Study Group and the National Institute. N Engl J Med. 1994 Nov 17;331(20):1325–1330. doi: 10.1056/NEJM199411173312001. [DOI] [PubMed] [Google Scholar]
  12. Richet H. M., Andremont A., Tancrede C., Pico J. L., Jarvis W. R. Risk factors for candidemia in patients with acute lymphocytic leukemia. Rev Infect Dis. 1991 Mar-Apr;13(2):211–215. doi: 10.1093/clinids/13.2.211. [DOI] [PubMed] [Google Scholar]
  13. Stamos J. K., Rowley A. H. Candidemia in a pediatric population. Clin Infect Dis. 1995 Mar;20(3):571–575. doi: 10.1093/clinids/20.3.571. [DOI] [PubMed] [Google Scholar]
  14. Vincent J. L., Bihari D. J., Suter P. M., Bruining H. A., White J., Nicolas-Chanoin M. H., Wolff M., Spencer R. C., Hemmer M. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA. 1995 Aug 23;274(8):639–644. [PubMed] [Google Scholar]
  15. Weems J. J., Jr Candida parapsilosis: epidemiology, pathogenicity, clinical manifestations, and antimicrobial susceptibility. Clin Infect Dis. 1992 Mar;14(3):756–766. doi: 10.1093/clinids/14.3.756. [DOI] [PubMed] [Google Scholar]
  16. Wenzel R. P. Nosocomial candidemia: risk factors and attributable mortality. Clin Infect Dis. 1995 Jun;20(6):1531–1534. doi: 10.1093/clinids/20.6.1531. [DOI] [PubMed] [Google Scholar]
  17. Wey S. B., Mori M., Pfaller M. A., Woolson R. F., Wenzel R. P. Risk factors for hospital-acquired candidemia. A matched case-control study. Arch Intern Med. 1989 Oct;149(10):2349–2353. [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES