A retrospective study was performed in an Italian tertiary hospital to evaluate trends in candidaemia
between 1992 and 2001, and to compare the characteristics of episodes of fungaemia between 1992.1997
and 1998.2001. In total, 370 episodes of candidaemia were identified, with an average incidence of 0.99
episodes . 10 000 patient-days . year (range 0.49.1.29 episodes). On an annual trend basis, the overall
incidence was essentially stable in surgical and medical wards, but decreased in intensive care units
(ICUs) (p 0.0065). The average use of fluconazole was 37.9 g . 10 000 patient-days . year (range 21.4.
56.1 g), and did not change significantly during the 10-year period. Nearly two-thirds of patients were in
ICUs at the onset of candidaemia, but none was neutropenic in either study period. Candida albicans
remained the predominant species isolated (53.8% vs. 48.1%), followed by Candida parapsilosis, Candida
glabrata and Candida tropicalis, the distribution of which did not change significantly. The 30-day crude
mortality rate was essentially similar (44% vs. 35%) in both study periods. Thus the incidence of
nosocomial candidaemia, although high in this institution, decreased among critically-ill patients during
the 10-year period. This finding seemed to be related to an improvement in infection control practices,
particularly regarding the prevention of intravascular catheter-related infections in ICUs. Although the
overall use of fluconazole was considerable, no increase in azole-resistant non-albicans Candida spp. was
detected.
