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Journal of Clinical Microbiology, March 1999, p. 531-537, Vol. 37, No. 3
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

Trends in Antifungal Use and Epidemiology of Nosocomial Yeast Infections in a University Hospital

Yasmina F. Berrouane,1,dagger Loreen A. Herwaldt,1,2,3,* and Michael A. Pfaller4

Departments of Internal Medicine1 and Pathology,4 University of Iowa College of Medicine, Program of Hospital Epidemiology, University of Iowa Hospitals and Clinics,2 and Veterans Affairs Medical Center,3 Iowa City, Iowa

Received 17 June 1998/Returned for modification 12 August 1998/Accepted 12 December 1998

This report describes both the trends in antifungal use and the epidemiology of nosocomial yeast infections at the University of Iowa Hospitals and Clinics between fiscal year (FY) 1987-1988 and FY 1993-1994. Data were gathered retrospectively from patients' medical records and from computerized databases maintained by the Pharmacy, the Program of Hospital Epidemiology, and the Medical Records Department. After fluconazole was introduced, use of ketoconazole decreased dramatically but adjusted use of amphotericin B decreased only moderately. However, the proportion of patients receiving antifungal therapy who were treated with amphotericin B declined markedly. In FY 1993-1994, 26 patients of the gastrointestinal surgery service received fluconazole. Among these patients, fluconazole use was prophylactic in 16 (61%), empiric in 3 (12%), and directed to a documented fungal infection in 7 (27%). Rates of nosocomial yeast infection in the adult bone marrow transplant unit increased from 6.77/1,000 patient days in FY 1987-1988 to 10.18 in FY 1989-1990 and then decreased to 0 in FY 1992-1993. Rates of yeast infections increased threefold in the medical and surgical intensive care units, reaching rates in FY 1993-1994 of 6.95 and 5.25/1,000 patient days, respectively. The rate of bloodstream infections increased from 0.044/1,000 patient days to 0.098, and the incidence of catheter-related urinary tract infections increased from 0.23/1,000 patient days to 0.68. Although the proportion of infections caused by yeast species other than Candida albicans did not increase consistently, C. glabrata became an important nosocomial pathogen.

* Corresponding author. Mailing address: C41 GH, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242-1081. Phone: (319) 356-0474. Fax: (319) 353-8687. E-mail: loreen-herwaldt{at}uiowa.edu.

dagger Present address: Unité de la Lutte contre les Infections Nosocomiales, CHRU de Lille, Hôpital A. Calmette, 50 037 Lille Cedex, France.

Journal of Clinical Microbiology, March 1999, p. 531-537, Vol. 37, No. 3
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.


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