Course: Opportunistic Fungi in the Immunocompromised Patient
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The Changing Face of the Fungal Kingdom
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The Rise in Nosocomial Infections

The Centers for Disease Control and Prevention (Atlanta) estimates that hospital-acquired infections affect approximately 2 million persons annually, and in 1992 cost more than $4.5 billion [4]. About 250,000 cases of bloodstream infection (BSI) occur annually, engendering an attributable mortality of 35%, 24 days of additional hospital stay, and excess hospital costs of $40,000 per survivor [5]. The National Nosocomial Infections Surveillance (NNIS) System conducts prospective surveillance of nosocomial infections. By the late 1980s, hospitalwide and ICU surveillance reported an increased prevalence [6] of pathogens not previously associated with the hospital setting. Of particular note was the emergence of Candida species as the sixth most common infection reported hospitalwide and the fourth most common pathogen among nosocomial BSIs [6]. Alarming secular trends were also noted, with a fivefold increase in incidence of bloodstream fungal infection over the decade (Fig 1).

figure 1

A recent report [7] from the Surveillance and Control of Pathogens of Epidemiologic Importance Project (SCOPE) confirmed that Candida species remain ranked fourth in order of nosocomial BSIs at 49 hospitals throughout the United States from 1995 to 1998 (Table 2). Candida albicans accounted for 46.8% of the isolates, with C glabrata, C parapsilosis, and C tropicalis accounting for 90% of the other isolates. Importantly, in this study Candida species Infections were associated the highest crude mortality (40%) compared to bacteria.

Increasingly, high-risk areas such as neonatal and surgical intensive care units account for as much as 25% to 50% of the reported cases of nosocomial infections. Data collected from 9 different types of ICU from January 1990 through May 1999 showed that Candida albicans remained the fourth most common isolate from BSIs. The report included data for isolates from urinary-tract infections where it was second [8]. Of interest was the ranking of Candida spp in comparison with bacterial infections such as Escherichia coli and Staphylococcus aureus (Fig 2).

figure 2

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The Changing Face of the Fungal Kingdom
   Factors Influencing the Emergence of Opportunistic Fungal Infections
   The Susceptible Host
   The Rise in Nosocomial Infections

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Course Number: V035B.043001

This CME Expires on July 1, 2003; no tests will be accepted after this date.

This course is accredited by The University of Pittsburgh School of Medicine, Center for Continuing Education

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