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409. Changing Epidemiology of Fungal Bloodstream Infections in a Tertiary Care Center in India

BACKGROUND: Despite a significant increase in fungal blood stream (BSI) infections in India, there is paucity of data on regional prevalence of major fungal species, and risk factors for this infection. We describe the epidemiology and predictors of fungal BSI in a tertiary care center in Kerala, In...

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Autores principales: Menon, Vidya, P, Binny P, T, Fabia E, Singh, Sanjeev, Kaye, Keith S, Patel, Payal
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6255679/
http://dx.doi.org/10.1093/ofid/ofy210.420
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author Menon, Vidya
P, Binny P
T, Fabia E
Singh, Sanjeev
Kaye, Keith S
Patel, Payal
author_facet Menon, Vidya
P, Binny P
T, Fabia E
Singh, Sanjeev
Kaye, Keith S
Patel, Payal
author_sort Menon, Vidya
collection PubMed
description BACKGROUND: Despite a significant increase in fungal blood stream (BSI) infections in India, there is paucity of data on regional prevalence of major fungal species, and risk factors for this infection. We describe the epidemiology and predictors of fungal BSI in a tertiary care center in Kerala, India with a novel antimicrobial stewardship program in place. METHODS: Data on adult inpatients who had at least one positive fungal culture from blood samples were collected from electronic medical records over a period of 48 months (January 2012 and December 2015). Year wise epidemiology and risk factor characterization of fungal BSI were done using χ(2) method. RESULTS: A total of 219 fungal BSI were identified with incidence of 1.08 cases/1,000 patients and there was a 15% decrease over the 4-year period. There was a 300% increase in fungal BSI in patients older than 80 years. Candida was the most common cause of fungal BSI (92%), with a 100% increase in incidence of C. glabrata and C. haemolunii, and a 45% decrease in C. parapsilosis seen over the 4-year period. Community-acquired fungal BSI increased by 700% while hospital-associated infections dropped by 29%. Twenty-three percent decrease in inappropriate antifungal treatment was observed from 2012 to 2015. Isolates reflected a 71% increase in resistance to amphotericin B and a 114% increase in fluconazole resistance. Thirty-one percent reduction in all-cause mortality was seen in the cohort over the study period. Among the risk factors for fungal BSI, ICU stay, use of urinary catheter, surgery, neutropenia, and diabetes decreased while prior antibiotic use and steroid use significantly increased over the years (P < 0.05). Predictors of mortality included male gender, prior use of antibiotics, ICU stay, use of ventilator, chemotherapy, chronic liver disease, hypertension, presence of Candida parapsilosis, and inappropriate therapy (P < 0.05). CONCLUSION: A significant shift in fungal BSI epidemiology was observed in our center with increase in overall antifungal resistance. Antimicrobial stewardship and infection control programs may have contributed to reduced mortality and reduced hospital-associated infections. [Image: see text] DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-62556792018-11-28 409. Changing Epidemiology of Fungal Bloodstream Infections in a Tertiary Care Center in India Menon, Vidya P, Binny P T, Fabia E Singh, Sanjeev Kaye, Keith S Patel, Payal Open Forum Infect Dis Abstracts BACKGROUND: Despite a significant increase in fungal blood stream (BSI) infections in India, there is paucity of data on regional prevalence of major fungal species, and risk factors for this infection. We describe the epidemiology and predictors of fungal BSI in a tertiary care center in Kerala, India with a novel antimicrobial stewardship program in place. METHODS: Data on adult inpatients who had at least one positive fungal culture from blood samples were collected from electronic medical records over a period of 48 months (January 2012 and December 2015). Year wise epidemiology and risk factor characterization of fungal BSI were done using χ(2) method. RESULTS: A total of 219 fungal BSI were identified with incidence of 1.08 cases/1,000 patients and there was a 15% decrease over the 4-year period. There was a 300% increase in fungal BSI in patients older than 80 years. Candida was the most common cause of fungal BSI (92%), with a 100% increase in incidence of C. glabrata and C. haemolunii, and a 45% decrease in C. parapsilosis seen over the 4-year period. Community-acquired fungal BSI increased by 700% while hospital-associated infections dropped by 29%. Twenty-three percent decrease in inappropriate antifungal treatment was observed from 2012 to 2015. Isolates reflected a 71% increase in resistance to amphotericin B and a 114% increase in fluconazole resistance. Thirty-one percent reduction in all-cause mortality was seen in the cohort over the study period. Among the risk factors for fungal BSI, ICU stay, use of urinary catheter, surgery, neutropenia, and diabetes decreased while prior antibiotic use and steroid use significantly increased over the years (P < 0.05). Predictors of mortality included male gender, prior use of antibiotics, ICU stay, use of ventilator, chemotherapy, chronic liver disease, hypertension, presence of Candida parapsilosis, and inappropriate therapy (P < 0.05). CONCLUSION: A significant shift in fungal BSI epidemiology was observed in our center with increase in overall antifungal resistance. Antimicrobial stewardship and infection control programs may have contributed to reduced mortality and reduced hospital-associated infections. [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6255679/ http://dx.doi.org/10.1093/ofid/ofy210.420 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Menon, Vidya
P, Binny P
T, Fabia E
Singh, Sanjeev
Kaye, Keith S
Patel, Payal
409. Changing Epidemiology of Fungal Bloodstream Infections in a Tertiary Care Center in India
title 409. Changing Epidemiology of Fungal Bloodstream Infections in a Tertiary Care Center in India
title_full 409. Changing Epidemiology of Fungal Bloodstream Infections in a Tertiary Care Center in India
title_fullStr 409. Changing Epidemiology of Fungal Bloodstream Infections in a Tertiary Care Center in India
title_full_unstemmed 409. Changing Epidemiology of Fungal Bloodstream Infections in a Tertiary Care Center in India
title_short 409. Changing Epidemiology of Fungal Bloodstream Infections in a Tertiary Care Center in India
title_sort 409. changing epidemiology of fungal bloodstream infections in a tertiary care center in india
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6255679/
http://dx.doi.org/10.1093/ofid/ofy210.420
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