Opportunistic candidiasis: an epidemic of the 1980s.

Hospital discharge data from 1980 to 1989 from the National Center for Health Statistics, National Hospital Discharge Survey (NHDH), and two commercially generated hospital discharge data sources (PAS and McAuto) were analyzed to document nationally the increased rate of opportunistic candidal infections among hospitalized patients in the 1980s and to identify the major risk factors. National projections were made by year. Age-, sex-, race-, and disease-specific denominators were generated from NHDS data. ICD-9-CM codes derived from discharge diagnoses were used to identify patients with oropharyngeal candidiasis, disseminated candidiasis, human immunodeficiency virus (HIV) infection/AIDS, or malignancies and transplants. Between 1980 and 1989, rates of oropharyngeal candidiasis increased 4.7 times (from 0.34 to 1.6 cases per 1,000 admissions per year), and the number of deaths among patients with oropharyngeal candidiasis increased fivefold. Although the highest rates were among pediatric patients (3 cases per 1,000 pediatric admissions), the greatest rate increases were among 15- to 44-year-old patients (13-fold) and males (fivefold). Between 1983 and 1989, the rates of oropharyngeal candidiasis among patients with HIV infections/AIDS rose more than 22 times (from 0.02 to 0.45 case per 1,000 admissions; NHDS data). Over the whole decade, the rates of disseminated candidiasis increased 11 times (from 0.013 to 0.15 case per 1,000 admissions). Between 1985 and 1989, the rate of this complication among patients with HIV infection/AIDS increased 10-fold, compared with only a twofold rate increase among patients with malignancies or transplants. The rate of debilitating and life-threatening candidiasis among hospitalized patients increased considerably over the 1980s. This rate increase was significant among patients with HIV infection/AIDS and patients undergoing transplantation or immunosuppressive therapy for malignancies.

[1]  K. Powell,et al.  The incidence of hospitalized cases of systemic mycotic infections. , 1974, Sabouraudia.

[2]  J. Meyers.  Fungal infections in bone marrow transplant patients. , 1990, Seminars in oncology.

[3]  M. Moro,et al.  Nosocomial outbreak of systemic candidosis associated with parenteral nutrition. , 1990 .

[4]  G. Rutherford,et al.  The prevalence of oral lesions in HIV‐infected homosexual and bisexual men: three San Francisco epidemiological cohorts , 1991, AIDS.

[5]  B. Plikaytis,et al.  Aspergillosis and other systemic mycoses. The growing problem. , 1979, JAMA.

[6]  R. Lin,et al.  The role of oral candidiasis in survival and hospitalization patterns: analysis of an inner city hospital human immunodeficiency virus/acquired immune deficiency syndrome registry. , 1993, The American journal of the medical sciences.

[7]  E. Reed,et al.  Clinical features and analysis of risk factors for invasive candidal infection after marrow transplantation. , 1991, The Journal of infectious diseases.

[8]  B. Strom,et al.  Risk factors for nosocomial candidemia: a case-control study in adults without leukemia. , 1989, The American journal of medicine.

[9]  T. Young,et al.  The causes of esophageal symptoms in human immunodeficiency virus infection. A prospective study of 110 patients. , 1991, Archives of internal medicine.

[10]  H. Richet,et al.  Risk factors for candidemia in patients with acute lymphocytic leukemia. , 1991, Reviews of infectious diseases.

[11]  W. Vaudry,et al.  Investigation of a cluster of systemic Candida albicans infections in a neonatal intensive care unit. , 1988, The Journal of infectious diseases.

[12]  R. Stratta,et al.  Clinical spectrum of fungal infections after orthotopic liver transplantation. , 1991, Archives of surgery.

[13]  F. Meunier,et al.  Candidemia in immunocompromised patients. , 1992, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  C. Beck-Sague,et al.  Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980-1990. National Nosocomial Infections Surveillance System. , 1993, The Journal of infectious diseases.

[15]  R. Woolson,et al.  Risk factors for hospital-acquired candidemia. A matched case-control study. , 1989, Archives of internal medicine.

[16]  B. Yangco,et al.  Epidemiology and infectious complications of human immunodeficiency virus antibody positive patients. , 1993, Advances in experimental medicine and biology.

[17]  T. Walsh,et al.  The child with cancer and infection. II. Nonbacterial infections. , 1991, The Journal of pediatrics.

[18]  T. Walsh,et al.  The child with cancer and infection. I. Empiric therapy for fever and neutropenia, and preventive strategies. , 1991, The Journal of pediatrics.