Secular Trends in the Epidemiology of Nosocomial Fungal Infections at a Teaching Hospital in Taiwan, 1981 to 1993

Abstract

Objective: To describe the incidence and patterns of nosocomial fungal infection in a large teaching hospital in Taiwan. Design: Prospective, hospitalwide nosocomial surveillance data from 1981 through 1993 were analyzed to show the secular trend in nosocomial fungal infection rates and to identify the most common pathogens and sites of infection (other than skin) in this hospital. Setting and Patients: The National Taiwan University Hospital is a medical school-affiliated hospital in the city of Taipei, Taiwan, with a 1,200-bed capacity before 1991 and 1,500 beds since 1992. It provides both primary and tertiary medical care. Results: The overall nosocomial fungal infection rate rose from 0.9 infections per 1,000 discharges in 1981 to 6.6 per 1,000 discharges in 1993, with the highest rate at the medical intensive-care unit (26.5/1,000 discharges in 1993). This increase in infection rate was found at four major anatomic sites of infection, particularly including the bloodstream (0.08-2.19/1,000 discharges) and the urinary tract (0.36-2.95/1,000 discharges). Of 256 pathogens causing nosocomial fungemia from 1981 through 1993, Candida albicans was the most commonly isolated (50.8%), followed by Candida tropicalis (17.6%), Candida parapsilosis (11.7%), and Candida glabrata (8.2%). As compared to isolates from 1981 through 1988, the proportion of C parapsilosis and C glabrata isolated between 1989 and 1993 increased more than sixfold and fourfold, respectively. The increasing importance of fungal infections was confirmed further by the increased use of amphotericin B and azoles in this hospital. Conclusions: Candida species and other yeasts have become a prominent cause of nosocomial infections in this hospital. These fungal pathogens accounted for a higher proportion of nosocomial bloodstream and urinary infections than any single bacterial species. Therefore, it is important to conduct a prospective epidemiological study and to establish in vitro antifungal susceptibility testing to enhance efforts to control nosocomial fungal infections and to minimize the risk of emergence of antifungal resistance.