Non-albicans Candida species
The objective of the Hospital Infection Surveillance System (KISS) is to collect data on the frequency and types of nosocomial infections, including organisms with particular epidemiological relevance for intensive care units. Candida species are an important cause of catheter-related bloodstream infections in critically ill patients. In the United States, Candida spp are the fourth most common cause of nosocomial bloodstream infections, and, depending on overall patient morbidity, they are associated with a case fatality rate of up to 50%. Apart from Candida albicans, infections with non-albicans Candida spp are increasingly observed. Currently, worldwide, approximately 50% of cases of candidemia are caused by non-albicans Candida species. These non-albicans Candida spp are of particular clinical relevance as they are associated with increased frequencies of resistance to currently available systemic antimycotic drugs (1–3). It is against this background that the KISS data presented in the article (4) only partly reflect the epidemiology of catheter-related candidemia in German intensive care units. The only listed Candida spp. is Candida albicans – the group of non-albicans Candida spp. is entirely omitted from the analysis. This way of presentation, however, results in a marked underestimation of the magnitude of invasive Candida infections: Assuming –based on current literature data- a prevalence of 50% of non-albicans Candida spp., bloodstream infections due to Candida would be third in frequency of catheter-associated infections in German intensive care units with completely different implications for preventive and therapeutic strategies.
Given the complete lack of other patient-related analyses on the epidemiology of invasive Candida infections in Germany, I would very much encourage the authors to complete their analysis and to include non-albicans Candida spp. If data on non-albicans Candida catheter associated infections are not yet collected in KISS, I strongly recommend to reconsider this approach and to capture all catheter-associated infections due to Candida spp in this well-organized and so important surveillance network.
Prof. Dr. med. Andreas H. Groll
Universitätsklinikum Münster, Albert-Schweitzer-Str. 33
48149 Münster, Germany, firstname.lastname@example.org
|1.||Pappas PG, Kauffman CA, Andes D, et al.: Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 48: 503–35. MEDLINE|
|2.||Tortorano AM, Peman J, Bernhardt H, et al.: ECMM Working Group on Candidaemia: Epidemiology of candidaemia in Europe: results of 28-month European Confederation of Medical Mycology (ECMM) hospital-based surveillance study. Eur J Clin Microbiol Infect Dis 2004; 23: 317–22. MEDLINE|
|3.||Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB: Nosocomial bloodstream infections in US hospitals: analysis of 24179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004; 39: 309–17. MEDLINE|
|4.||Geffers C, Gastmeier P: Nosocomial infections and multidrug-resistance organisms in Germany—epidemiological data from KISS (The Hospital Infection Surveillance System). Dtsch Arztebl Int 2011; 108(6): 87–93.|