Fungal Infections in Critically III Surgical Patients

Abstract

Nosocomial infections are increasingly caused by fungi, with a more than 400% increase in fungal infections in academic teaching hospitals in the United States during the 1980s [1]. Currently, 7–10% of bloodstream infections in the United States are caused by Candida species [2–6]; with yeast accounting for 15% of bloodstream isolates in the period from 1992–1995 at the Johns Hopkins Hospital [7]. In 307 Candida bloodstream infections from 34 SENTRY participating centers, 80% of the bloodstream infections were nosocomial and 50% occurred in the intensive care unit (ICU) [8]. At the University of Iowa Hospitals and Clinics in the fiscal year 1992–1993 the rates of fungal infections in the medical and surgical ICUs were 6.95 and 5.25/1000 patient days, respectively [9]. The rate of bloodstream infections were compared between the fiscal years 1997–1998 and 1993–1994 and increased from 0.044/1000 patient days to 0.098, and the incidence of catheter-related urinary tract infections increased from 0.23/1000 patient days to 0.68 [9]. These studies probably understate the importance of Candida species as nosocomial pathogens in the ICU, as several autopsy studies have shown that Candida infections are often undiagnosed ante-mortem.