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Emerging and Reemerging Microbial Threats: Nosocomial Fungal Infections

Emerging and Reemerging Microbial Threats: Nosocomial Fungal Infections Abstract The incidence of nosocomial fungal infections has been increasing steadily for the past 25 years. Although they were once believed to be of little clinical consequence, there is now compelling evidence that fungal agents represent a bona fide microbial threat with substantial morbidity and high mortality.1,2 Reporting on a series of 30 447 nosocomial fungal infections that occurred in the decade from 1980 to 1990, Beck-Sague and Jarvis3 noted increases in incidence from 90% to 175%. Infection rates rose from 2.0 per 1000 discharges to as high as 6.6 infections per 1000 discharges. Fungal infections increased at all major anatomic sites, including surgical wounds, lung, urinary tract, and bloodstream. Candida species accounted for 78.3% of nosocomial fungal infections, while Torulopsis species and Aspergillus species accounted for 7.3% and 1.3%, respectively. (Arch Surg. 1996;131:330-337) References 1. Fraser VJ, Jones M, Dunkel J, Storfer S, Medoff G, Dunagan WC. Candidemia in a tertiary care hospital: epidemiology, risk factors, and predictors of mortality [see comments] . Clin Infect Dis . 1992;15:414-421.Crossref 2. Ellis CA, Spivack ML. The significance of candidemia . Ann Intern Med . 1967; 67:511-522.Crossref 3. Beck-Sague C, Jarvis WR. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980-1990: National Nosocomial Infections Surveillance System . J Infect Dis . 1993;167:1247-1251.Crossref 4. Banerjee SN, Emori TG, Culver DH, et al. Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989: National Nosocomial Infections Surveillance System . Am J Med . 1991;91:86S-89S.Crossref 5. Jarvis WR. Nosocomial outbreaks: the Centers for Disease Control's Hospital Infections Program experience, 1980-1990: Epidemiology Branch, Hospital Infections Program . Am J Med . 1991;91:101S-101S.Crossref 6. Harvey RL, Myers JP. Nosocomial fungemia in a large community teaching hospital . Arch Intern Med . 1987;147:2117-2120.Crossref 7. Wey SB, Mori M, Pfaller MA, Woolson RF, Wenzel RP. Risk factors for hospital-acquired candidemia: a matched case-control study . Arch Intern Med . 1989; 149:2349-2353.Crossref 8. Sherertz RJ, Gledhill KS, Hampton KD, et al. Outbreak of Candida bloodstream infections associated with retrograde medication administration in a neonatal intensive care unit . J Pediatr . 1992;120:455-461.Crossref 9. Wey SB, Mori M, Pfaller MA, Woolson RF, Wenzel RP. Hospital-acquired candidemia: the attributable mortality and excess length of stay . Arch Intern Med . 1988;148:2642-2645.Crossref 10. Arnow PM, Quimosing EM, Beach M. Consequences of intravascular catheter sepsis . Clin Infect Dis . 1993;16:778-784.Crossref 11. Rex JH, Bennett JE, Sugar AM, et al. A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia: Candidemia Study Group and the National Institute [see comments] . N Engl J Med . 1994;331:1325-1330.Crossref 12. Stone HH, Kolb LD, Currie CA, Geheber CE, Cuzzell JZ. Candida sepsis: pathogenesis and principles of treatments . Ann Surg . 1974;179:697-711.Crossref 13. Komshian SV, Uwaydah AK, Sobel JD, Crane LR. Fungemia caused by Candida species and Torulopsis glabrata in the hospitalized patient: frequency, characteristics, and evaluation of factors influencing outcome . Rev Infect Dis . 1989; 11:379-390.Crossref 14. Nassoura Z, Ivatury RR, Simon RJ, Jabbour N, Stahl WM. Candiduria as an early marker of disseminated infection in critically ill surgical patients: the role of fluconazole therapy . J Trauma . 1993;35:290-295.Crossref 15. Menezes AV, Sigesmund DA, Demajo WA, Devenyi RG. Mortality of hospitalized patients with Candida endophthalmitis . Arch Intern Med . 1994;154:2093-2097.Crossref 16. Bartlett JG. Fungal infections . In: Nichols RL, Hyslop NE Jr, Bartlett JG, eds. Decision Making in Surgical Sepsis . St Louis, Mo: Mosby-Year Book; 1991: 382-386. 17. Odds FC. Pathogenesis of Candida infections . J Am Acad Dermatol . 1994;31: S2-S5.Crossref 18. Ibrahim AS, Mirbod F, Filler SG, et al. Evidence implicating phospholipase as a virulence factor of Candida albicans . Infect Immun . 1995;63:1993-1998. 19. Neely AN, Orloff MM, Holder IA. Candida albicans growth studies: a hypothesis for the pathogenesis of Candida infections in burns . J Burn Care Rehabil . 1992;13:323-329.Crossref 20. Raad II, Bodey GP. Infectious complications of indwelling vascular catheters . Clin Infect Dis . 1992;15:197-208.Crossref 21. Dato VM, Dajani AS. Candidemia in children with central venous catheters: role of catheter removal and amphotericin B therapy . Pediatr Infect Dis . 1990; 9:309-314.Crossref 22. Eppes S, Troutman J, Gutman J. Outcome of treatment of candidemia in children whose central catheters were removed or retained . Pediatr Infect Dis . 1989;8:99-104.Crossref 23. Hostetter MK. Handicaps to host defense: effects of hyperglycemia on C3 and Candida albicans . Diabetes . 1990;39:271-275.Crossref 24. Samaranayake YH, Samaranayake LP. Candida krusei: biology, epidemiology, pathogenicity and clinical manifestations of an emerging pathogen . J Med Microbiol . 1994;41:295-310.Crossref 25. Sanford G, Merz W, Wingard J, et al. The value of fungal surveillance cultures as predictors of systemic fungal infections . J Infect Dis . 1980:142:503-509.Crossref 26. Walsh TJ, Merz WG. Pathologic features in the human alimentary tract associated with invasiveness of Candida tropicalis . Am J Clin Pathol . 1986;85:498-502. 27. Chapman SW, Daniel CR. Cutaneous manifestations of fungal infection . Infect Dis Clin North Am . 1994;8:879-910. 28. McMahon MM, Bistrian BR. Host defenses and susceptibility to infection in patients with diabetes mellitus . Infect Dis Clin North Am . 1995:9:1-9. 29. Marshall JC, Christou NV, Meakins JL. The gastrointestinal tract: the 'undrained abscess' of multiple organ failure [see comments] . Ann Surg . 1993; 218:111-119.Crossref 30. Alexander JW, Boyce ST, Babcock GF, et al. The process of microbial translocation . Ann Surg . 1990;212:496-511.Crossref 31. Hashimoto T. In-vitro study of contact-mediated killing of Candida albicans hyphae by activated murine peritoneal macrophages in a serum-free medium . Infect Immun . 1991;59:3555-3561. 32. Dyess DL, Garrison RN, Fry DE. Candida sepsis: implications of polymicrobial blood-borne infection . Arch Surg . 1985;120:345-348.Crossref 33. Edwards JE Jr. Candidemia and Candida catheter-associated sepsis : In: Holmberg K, Meyer RD. eds. Diagnosis and Therapy of Systemic Fungal Infections . New York, NY: Raven Press; 1989:39-46. 34. Edwards JE. Editorial response: should all patients with candidemia be treated with antifungal agents? Clin Infect Dis . 1992;15:422-423.Crossref 35. Burchard KW, Minor LB. Slotman GJ. Gann DS. Fungal sepsis in surgical patients . Arch Surg . 1983:118:217-221.Crossref 36. Parke DW, Jones DB, Gentry LO. Endogenous endophthalmitis among patients with candidemia . Ophthalmology . 1982;89:789-796.Crossref 37. Edwards JE, Montgomerie JZ, Ishida K, Morrison JO, Guze LB. Experimental hematogenous endophthalmitis due to Candida: species variation in ocular pathogenicity . J Infect Dis . 1977;135:294-297.Crossref 38. Edwards JE Jr. Foos RY, Montgomerie JZ, Guze LB. Ocular manifestations of Candida septicemia: review of seventy-six cases of hematogenous Candida endophthalmitis . Medicine . 1974;53:47-75.Crossref 39. Horn R, Wong B, Kiehn TE, Armstrong D. Fungemia in a cancer hospital: changing frequency, earlier onset, and results of therapy . Rev Infect Dis . 1985;7: 646-655.Crossref 40. Solomkin JS, Flohr AB, Quie PG, Simmons RL. The role of Candida in intraperitoneal infections . Surgery . 1980;88:524-530. 41. Becker WK, Cioffi WG, McManus AT, et al. Fungal burn wound infection: a 10-year experience . Arch Surg . 1991;126:44-48.Crossref 42. Vasquez JA, Sobel JD. Fungal infections in the diabetic . Infect Dis Clin North Am . 1995;9:97-116. 43. Kones RJ, Cutitar M, Burchard KW. Perforated peptic ulcer: determinants of morbidity and mortality . Am Surg . 1990;56:280-284. 44. Cornwell EE, Belzberg H, Offne TV, et al. The pattern of fungal infections in critically ill surgical patients . Am Surg . 1995;61:847-850. 45. Repentigny LD. Serodiagnosis of candidiasis, aspergillosis, and cryptococcosis . Clin Infect Dis . 1992;14:S11-S22.Crossref 46. De Repentigny LD, Marr LD, Keller JW, et al. Comparison of enzyme immunoassay and gas-liquid chromatography for the rapid diagnosis of invasive candidiasis in cancer patients . J Clin Microbiol . 1985;21:972-979. 47. Ormala T, Korppi M, Katila ML, Ojanen T, Perkkio M. Prospective evaluation of Candida antigen and antibody assays for detection of Candida infections in children with malignant disease . Acta Paediatr . 1995;84:183-187.Crossref 48. Chryssanthou E, Andersson B, Petrini B, Lofdahl S, Tollemar J. Detection of Candida albicans DNA in serum by polymerase chain reaction . Scand J Infect Dis . 1994;26:479-485.Crossref 49. Rand KH, Houck H, Wolff M. Detection of candidemia by polymerase chain reaction . Mol Cell Probes . 1994;8:215-221.Crossref 50. Karp JE. Merz WG, Churache P. Response to empiric amphotericin B during antileukemic therapy-induced granulocytopenia . Rev Infect Dis . 1991;13:592-599.Crossref 51. EORTC International Antimicrobial Cooperative Group. Empiric antifungal therapy in febrile granulocytopenic patients . Am J Med . 1989;86:668-672.Crossref 52. Hughes WT, Armstrong D, Bodey GP, et al. Guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever . J Infect Dis . 1990; 161:381-396.Crossref 53. Marsh PK, Tally FP, Kellum J, Callow A. Gorbach SL. Candida infections in surgical patients . Ann Surg . 1983;198:42-47.Crossref 54. Paya CV. Fungal infections in solid-organ transplantation . Clin Infect Dis . 1993; 16:677-688.Crossref 55. Perfect JR, Pickard WW, Hunt DL, Palmer B, Schell WA. The use of amphotericin B in nosocomial fungal infection . Rev Infect Dis . 1991;13:474-479.Crossref 56. Richardson K, Cooper K, Marriott MS, Tarbit MH, Troke PF, Whittle PJ. Discovery of fluconazole, a novel antifungal agent . Rev Infect Dis . 1990;12:S267-S271.Crossref 57. Bodey GP. Azole antifungal agents . Clin Infect Dis . 1992;14:S161-S169.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Emerging and Reemerging Microbial Threats: Nosocomial Fungal Infections

Henderson, Vernon J.; Hirvela, Elsa R.
Archives of Surgery , Volume 131 (3) – Mar 1, 1996
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References (64)

Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1996.01430150108020
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Abstract

Abstract The incidence of nosocomial fungal infections has been increasing steadily for the past 25 years. Although they were once believed to be of little clinical consequence, there is now compelling evidence that fungal agents represent a bona fide microbial threat with substantial morbidity and high mortality.1,2 Reporting on a series of 30 447 nosocomial fungal infections that occurred in the decade from 1980 to 1990, Beck-Sague and Jarvis3 noted increases in incidence from 90% to 175%. Infection rates rose from 2.0 per 1000 discharges to as high as 6.6 infections per 1000 discharges. Fungal infections increased at all major anatomic sites, including surgical wounds, lung, urinary tract, and bloodstream. Candida species accounted for 78.3% of nosocomial fungal infections, while Torulopsis species and Aspergillus species accounted for 7.3% and 1.3%, respectively. (Arch Surg. 1996;131:330-337) References 1. Fraser VJ, Jones M, Dunkel J, Storfer S, Medoff G, Dunagan WC. Candidemia in a tertiary care hospital: epidemiology, risk factors, and predictors of mortality [see comments] . Clin Infect Dis . 1992;15:414-421.Crossref 2. Ellis CA, Spivack ML. The significance of candidemia . Ann Intern Med . 1967; 67:511-522.Crossref 3. Beck-Sague C, Jarvis WR. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980-1990: National Nosocomial Infections Surveillance System . J Infect Dis . 1993;167:1247-1251.Crossref 4. Banerjee SN, Emori TG, Culver DH, et al. Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989: National Nosocomial Infections Surveillance System . Am J Med . 1991;91:86S-89S.Crossref 5. Jarvis WR. Nosocomial outbreaks: the Centers for Disease Control's Hospital Infections Program experience, 1980-1990: Epidemiology Branch, Hospital Infections Program . Am J Med . 1991;91:101S-101S.Crossref 6. Harvey RL, Myers JP. Nosocomial fungemia in a large community teaching hospital . Arch Intern Med . 1987;147:2117-2120.Crossref 7. Wey SB, Mori M, Pfaller MA, Woolson RF, Wenzel RP. Risk factors for hospital-acquired candidemia: a matched case-control study . Arch Intern Med . 1989; 149:2349-2353.Crossref 8. Sherertz RJ, Gledhill KS, Hampton KD, et al. Outbreak of Candida bloodstream infections associated with retrograde medication administration in a neonatal intensive care unit . J Pediatr . 1992;120:455-461.Crossref 9. Wey SB, Mori M, Pfaller MA, Woolson RF, Wenzel RP. Hospital-acquired candidemia: the attributable mortality and excess length of stay . Arch Intern Med . 1988;148:2642-2645.Crossref 10. Arnow PM, Quimosing EM, Beach M. Consequences of intravascular catheter sepsis . Clin Infect Dis . 1993;16:778-784.Crossref 11. Rex JH, Bennett JE, Sugar AM, et al. A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia: Candidemia Study Group and the National Institute [see comments] . N Engl J Med . 1994;331:1325-1330.Crossref 12. Stone HH, Kolb LD, Currie CA, Geheber CE, Cuzzell JZ. Candida sepsis: pathogenesis and principles of treatments . Ann Surg . 1974;179:697-711.Crossref 13. Komshian SV, Uwaydah AK, Sobel JD, Crane LR. Fungemia caused by Candida species and Torulopsis glabrata in the hospitalized patient: frequency, characteristics, and evaluation of factors influencing outcome . Rev Infect Dis . 1989; 11:379-390.Crossref 14. Nassoura Z, Ivatury RR, Simon RJ, Jabbour N, Stahl WM. Candiduria as an early marker of disseminated infection in critically ill surgical patients: the role of fluconazole therapy . J Trauma . 1993;35:290-295.Crossref 15. Menezes AV, Sigesmund DA, Demajo WA, Devenyi RG. Mortality of hospitalized patients with Candida endophthalmitis . Arch Intern Med . 1994;154:2093-2097.Crossref 16. Bartlett JG. Fungal infections . In: Nichols RL, Hyslop NE Jr, Bartlett JG, eds. Decision Making in Surgical Sepsis . St Louis, Mo: Mosby-Year Book; 1991: 382-386. 17. Odds FC. Pathogenesis of Candida infections . J Am Acad Dermatol . 1994;31: S2-S5.Crossref 18. Ibrahim AS, Mirbod F, Filler SG, et al. Evidence implicating phospholipase as a virulence factor of Candida albicans . Infect Immun . 1995;63:1993-1998. 19. Neely AN, Orloff MM, Holder IA. Candida albicans growth studies: a hypothesis for the pathogenesis of Candida infections in burns . J Burn Care Rehabil . 1992;13:323-329.Crossref 20. Raad II, Bodey GP. Infectious complications of indwelling vascular catheters . Clin Infect Dis . 1992;15:197-208.Crossref 21. Dato VM, Dajani AS. Candidemia in children with central venous catheters: role of catheter removal and amphotericin B therapy . Pediatr Infect Dis . 1990; 9:309-314.Crossref 22. Eppes S, Troutman J, Gutman J. Outcome of treatment of candidemia in children whose central catheters were removed or retained . Pediatr Infect Dis . 1989;8:99-104.Crossref 23. Hostetter MK. Handicaps to host defense: effects of hyperglycemia on C3 and Candida albicans . Diabetes . 1990;39:271-275.Crossref 24. Samaranayake YH, Samaranayake LP. Candida krusei: biology, epidemiology, pathogenicity and clinical manifestations of an emerging pathogen . J Med Microbiol . 1994;41:295-310.Crossref 25. Sanford G, Merz W, Wingard J, et al. The value of fungal surveillance cultures as predictors of systemic fungal infections . J Infect Dis . 1980:142:503-509.Crossref 26. Walsh TJ, Merz WG. Pathologic features in the human alimentary tract associated with invasiveness of Candida tropicalis . Am J Clin Pathol . 1986;85:498-502. 27. Chapman SW, Daniel CR. Cutaneous manifestations of fungal infection . Infect Dis Clin North Am . 1994;8:879-910. 28. McMahon MM, Bistrian BR. Host defenses and susceptibility to infection in patients with diabetes mellitus . Infect Dis Clin North Am . 1995:9:1-9. 29. Marshall JC, Christou NV, Meakins JL. The gastrointestinal tract: the 'undrained abscess' of multiple organ failure [see comments] . Ann Surg . 1993; 218:111-119.Crossref 30. Alexander JW, Boyce ST, Babcock GF, et al. The process of microbial translocation . Ann Surg . 1990;212:496-511.Crossref 31. Hashimoto T. In-vitro study of contact-mediated killing of Candida albicans hyphae by activated murine peritoneal macrophages in a serum-free medium . Infect Immun . 1991;59:3555-3561. 32. Dyess DL, Garrison RN, Fry DE. Candida sepsis: implications of polymicrobial blood-borne infection . Arch Surg . 1985;120:345-348.Crossref 33. Edwards JE Jr. Candidemia and Candida catheter-associated sepsis : In: Holmberg K, Meyer RD. eds. Diagnosis and Therapy of Systemic Fungal Infections . New York, NY: Raven Press; 1989:39-46. 34. Edwards JE. Editorial response: should all patients with candidemia be treated with antifungal agents? Clin Infect Dis . 1992;15:422-423.Crossref 35. Burchard KW, Minor LB. Slotman GJ. Gann DS. Fungal sepsis in surgical patients . Arch Surg . 1983:118:217-221.Crossref 36. Parke DW, Jones DB, Gentry LO. Endogenous endophthalmitis among patients with candidemia . Ophthalmology . 1982;89:789-796.Crossref 37. Edwards JE, Montgomerie JZ, Ishida K, Morrison JO, Guze LB. Experimental hematogenous endophthalmitis due to Candida: species variation in ocular pathogenicity . J Infect Dis . 1977;135:294-297.Crossref 38. Edwards JE Jr. Foos RY, Montgomerie JZ, Guze LB. Ocular manifestations of Candida septicemia: review of seventy-six cases of hematogenous Candida endophthalmitis . Medicine . 1974;53:47-75.Crossref 39. Horn R, Wong B, Kiehn TE, Armstrong D. Fungemia in a cancer hospital: changing frequency, earlier onset, and results of therapy . Rev Infect Dis . 1985;7: 646-655.Crossref 40. Solomkin JS, Flohr AB, Quie PG, Simmons RL. The role of Candida in intraperitoneal infections . Surgery . 1980;88:524-530. 41. Becker WK, Cioffi WG, McManus AT, et al. Fungal burn wound infection: a 10-year experience . Arch Surg . 1991;126:44-48.Crossref 42. Vasquez JA, Sobel JD. Fungal infections in the diabetic . Infect Dis Clin North Am . 1995;9:97-116. 43. Kones RJ, Cutitar M, Burchard KW. Perforated peptic ulcer: determinants of morbidity and mortality . Am Surg . 1990;56:280-284. 44. Cornwell EE, Belzberg H, Offne TV, et al. The pattern of fungal infections in critically ill surgical patients . Am Surg . 1995;61:847-850. 45. Repentigny LD. Serodiagnosis of candidiasis, aspergillosis, and cryptococcosis . Clin Infect Dis . 1992;14:S11-S22.Crossref 46. De Repentigny LD, Marr LD, Keller JW, et al. Comparison of enzyme immunoassay and gas-liquid chromatography for the rapid diagnosis of invasive candidiasis in cancer patients . J Clin Microbiol . 1985;21:972-979. 47. Ormala T, Korppi M, Katila ML, Ojanen T, Perkkio M. Prospective evaluation of Candida antigen and antibody assays for detection of Candida infections in children with malignant disease . Acta Paediatr . 1995;84:183-187.Crossref 48. Chryssanthou E, Andersson B, Petrini B, Lofdahl S, Tollemar J. Detection of Candida albicans DNA in serum by polymerase chain reaction . Scand J Infect Dis . 1994;26:479-485.Crossref 49. Rand KH, Houck H, Wolff M. Detection of candidemia by polymerase chain reaction . Mol Cell Probes . 1994;8:215-221.Crossref 50. Karp JE. Merz WG, Churache P. Response to empiric amphotericin B during antileukemic therapy-induced granulocytopenia . Rev Infect Dis . 1991;13:592-599.Crossref 51. EORTC International Antimicrobial Cooperative Group. Empiric antifungal therapy in febrile granulocytopenic patients . Am J Med . 1989;86:668-672.Crossref 52. Hughes WT, Armstrong D, Bodey GP, et al. Guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever . J Infect Dis . 1990; 161:381-396.Crossref 53. Marsh PK, Tally FP, Kellum J, Callow A. Gorbach SL. Candida infections in surgical patients . Ann Surg . 1983;198:42-47.Crossref 54. Paya CV. Fungal infections in solid-organ transplantation . Clin Infect Dis . 1993; 16:677-688.Crossref 55. Perfect JR, Pickard WW, Hunt DL, Palmer B, Schell WA. The use of amphotericin B in nosocomial fungal infection . Rev Infect Dis . 1991;13:474-479.Crossref 56. Richardson K, Cooper K, Marriott MS, Tarbit MH, Troke PF, Whittle PJ. Discovery of fluconazole, a novel antifungal agent . Rev Infect Dis . 1990;12:S267-S271.Crossref 57. Bodey GP. Azole antifungal agents . Clin Infect Dis . 1992;14:S161-S169.Crossref

Journal

Archives of Surgery – American Medical Association

Published: Mar 1, 1996

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