Candidemia in a Regional Hospital without Infectious Diseases Department
10.2185/jjrm.60.18
- VernacularTitle:感染症科のない地域基幹病院におけるカンジダ血症の現状と課題
- Author:
Minoru MURAKAMI
;
Hirokazu KOMATSU
;
Yoshihiro TAKAYAMA
- Publication Type:Journal Article
- From:Journal of the Japanese Association of Rural Medicine
2011;60(1):18-23
- CountryJapan
- Language:Japanese
-
Abstract:
In Japan, there are many hospitals which do not have departments specializing in infectious diseases. Treatment of critical nosocomial infections such as candidemia is not sufficient and varies greatly from one institution to another. We reviewed the cases of candidemia in Saku Central Hospital from 2004 to 2008, and examined fungal species, clinical background, therapy, prognosis and the rate of treatment in accordance with the Infectious Diseases Society of America (IDSA) guidelines for candida infection. Blood culture revealed 43 cases diagnosed as candidemia. Candida albicans was the most common fungus. Antibiotics were administered to 84% of the patients and 79% had central venous catheters (CVC). The empirical antifungal administration included fosfluconazole and micafungin, but 23% of the patients did not receive any appropriate antifungal therapy. CVCs were removed from 23 of 34 patients, and 42% of the patients underwent ophthalmologic examination. Some of the patients (42%) were treated according to the IDSA guidelines, but most were not. The 28-day mortality rate was 33%. This study demonstrated that the strategy for treating candidemia in our hospital was insufficient, and also suggested that critical nosocomial infections cases were treated in adequately in many other regional hospitals in Japan. In conclusion, a well-organized and guideline-based therapeutic system is necessary in hospitals without the infectious diseases department.
