Background: The incidence of fungal healthcare-associated infection (HAI) has increased in a major teaching\r\nhospital in the northern part of Taiwan over the past decade, especially in the intensive care units (ICUs). The\r\npurpose of this study was to determine the factors that were responsible for the outbreak and trend in the ICU.\r\nMethods: Surveillance fungal cultures were obtained from ââ?¬Å?sterileââ?¬Â objects, antiseptic solutions, environment of\r\ninfected patients and hands of medical personnel. Risk factors for comparison included age, gender, admission\r\nservice, and total length of stay in the ICU, Acute Physiology and Chronic Health Evaluation (APACHE) II scores at\r\nadmission to the ICU, main diagnosis on ICU admission, use of invasive devices, receipt of hemodialysis, total\r\nparenteral nutrition (TPN) use, history of antibiotic therapy before HAI or during ICU stay in no HAI group, and ICU\r\ndischarge status (ie, dead or alive). Univariable analysis followed by multiple logistic regression analysis was\r\nperformed to identify the independent risk factors for ICU fungal HAIs and ICU mortality.\r\nResults: There was a significant trend in ICU fungal HAIs from 1998 to 2009 (P < 0.001). A total of 516 episodes of\r\nICU fungal HAIs were identified; the rates of various infections were urinary tract infection (UTI) (54.8%), blood\r\nstream infection (BSI) (30.6%), surgical site infection (SSI) (6.6%), pneumonia (4.5%), other sites (3.5%). The fungi\r\nidentified were: yeasts (54.8%), Candida albicans (27.3%), Candida tropicalis (6.6%), Candida glabrata (6.6%), Candida\r\nparapsilosis (1.9%), Candida species (0.8%), and other fungi (1.9%). Candida albicans accounted for 63% of all\r\nCandida species. Yeasts were found in the environment of more heavily infected patients. The independent risk\r\nfactors (P < 0.05) of developing ICU fungal HAIs from all sites were TPN use, sepsis, surgical patients, mechanical\r\nventilation and an indwelling urinary catheter. The independent risk factors for ICU fungal UTI included TPN use,\r\nmechanical ventilation and an indwelling urinary catheter. The independent risk factors for ICU fungal BSI included\r\nTPN use, sepsis, and higher APACHE II score. The independent risk factors for ICU fungal pneumonia included TPN\r\nuse, surgical patients. The independent risk factors for ICU fungal SSI included surgical patients, and TPN use. The\r\nodds ratios of TPN use in various infection types ranged from 3.51 to 8.82. The risk of mortality in patients with ICU\r\nfungal HAIs was over 2 times that of patients without ICU HAIs in the multiple logistic regression analysis\r\n(P < 0.001).
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