RESUMO
BACKGROUND: Blood stream infection due to candida species are becoming increasingly important causes of morbidity and mortality in hospitalized patients. The aim of this study was to obtain epidemiological data on candidemia in patients at King Abdulaziz University Hospital (KAUH), and to discuss the influence of several clinical variables on the development and outcome of candidemia. MATERIALS AND METHODS: Demographic information, risk factors, therapy and outcome of all patients who had candidemia at KAUH between January 1998 and December 1999 were reviewed. RESULTS: Thirty-one candidemic episodes were identified. All the candidemic episodes were hospital acquired. The most common risk factors to candidemia were central venous catheters (87%), stay in intensive care unit (ICU) (77%), and broad-spectrum antibiotics therapy (74%). Candida albicans was the most frequently isolated species (71%), followed by candida tropicalis and candida parapsilosis (13% each). Twenty-six patients (84%) were treated with amphotericin B, 4 (13%) with fluconazole, and one (3%) with ketoconazole. Antifungal susceptibility testing of the isolates in general revealed minimal levels of resistance to amphotericin B (3%) versus 39% resistance to fluconazole. Less than 5% of Candida albicans were resistant to amphotericin B, in comparison with >35% of these strains that were resistant to fluconazole. The overall mortality was 71%. Mortality was significantly associated with the presence of central venous catheters (P=0.001), stay in intensive care unit (P<0.001), and prolonged hospital stay before the onset of candidemia (P=0.05). CONCLUSION: Despite antifungal treatment, the mortality of candidemia is still high. Rapid changes in the rate of infection, potential risk factors, and emerging species demand continued and close surveillance of this serious infection.
RESUMO
OBJECTIVES: To study the episodes of Staph.aureus bacteremia diagnosed at King Abdulaziz University Hospital, to determine the source of infection, risk factors, the outcome of treatment and to compare our results with those reported in the literature. METHODS: A retrospective study in which the episodes of Staph.aureus bacteremia diagnosed at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia in the period from June 1996 to December 1998 were analyzed. RESULTS: A total of 103 episodes of Staph.aureus bacteremia were diagnosed in 95 patients with a mean age of 33.61 years (range 2 months to 90 years) and male:female ratio of 1.9:1. More than 50% of patients were Saudi nationals. Hospital-acquired infection was detected in 74% of the episodes versus 25% community-acquired. Methicillin resistant Staph.aureus was found in 29% of the episodes. Intravenous catheters and wounds were the main sources of bacteremic episodes (29% and 21%). The overall mortality was 32% with significant association with old age, diabetes mellitus and hemodialysis for renal failure. Risk factors such as surgical wounds, diabetes mellitus and malignancy, were more frequently associated with hospital-acquired than community-acquired bacteremia. Infective endocarditis was higher in patients with community-acquired bacteremia who had unknown source of infection. CONCLUSIONS: As discussed in the text, our results are comparable with those reported in the literature. Insertion of intravenous catheters under aseptic precaution, better care and judicious limitation of patients length of exposure to central line, in addition to proper wound dressings could reduce the frequency of blood stream infections.
