Impact of the changing epidemiology of fungal infections in the 1990s

  • M. Pfaller
  • R. Wenzel


The increase in fungal infections over the past decade is striking. This is particularly true for hospitalized patients where the rate of candidal bloodstream infection has increased by as much as 487 % over the decade of the 1980s. This increase in fungal infections is accompanied by a significant excess mortality and excess length of stay in hospital. The emergence of “new” fungal pathogens such asCandida krusei, Torulopsis glabrata, Fusarium andTrichosporon beigelii is now recognized as a significant problem in many patient populations. The documentation of nosocomial transmission of fungal pathogens and the recognition of resistance to both new and established antifungal agents poses a significant problem entering the 1990s. Continued effort is needed to develop new and better therapeutic agents and more effective strategies for prophylaxis of endogenous infections and prevention of transmission within the hospital setting.


Internal Medicine Patient Population Fungal Infection Therapeutic Agent Fungal Pathogen 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Anaisse EJ, Bodey GP, Kantarjian H, Ro J, Vartivarian SE, Hopfer R, Hoy J, Rolston K: New spectrum of fungal infections in patients with cancer. Reviews of Infectious Diseases 1989, 11: 369–378.Google Scholar
  2. 2.
    Anaisse EJ, Bodey GP, Rinaldi MD: Emerging fungal pathogens. European Journal of Clinical Microbiology and Infectious Diseases 1989, 8: 323–330.Google Scholar
  3. 3.
    Anaisse EJ, Bodey GP: Disseminated trichosporonosis: Meeting the challenge. European Journal of Clinical Microbiology and Infectious Diseases 1991, 10: 711–713.Google Scholar
  4. 4.
    Gamis AS, Gudnason T, Giebink GS, Ramsay NKC: Disseminated infection withFusarium in recipients of bone marrow transplants. Reviews of Infectious Diseases 1991, 13: 1077–1088.Google Scholar
  5. 5.
    Minor RL, Pfaller MA, Ginrich RD, Burns CP: DisseminatedFusarium infections in patients following bone marrow transplantation. Bone Marrow Transplantation 1989, 4: 653–658.Google Scholar
  6. 6.
    Pfaller MA: Infection control: opportunistic fungal infection — the increasing importance ofCandida species. Infection Control and Hospital Epidemiology 1989, 9: 408–416.Google Scholar
  7. 7.
    Wenzel RP, Pfaller MA:Candida species: emerging hospital bloodstream pathogens. Infection Control and Hospital Epidemiology 1991, 12: 523–524.Google Scholar
  8. 8.
    Banerjee SN, Emori TG, Culver DH, Gaynes RP, Jarvis WR, Horan T, Edwards JR, Tolson J, Henderson T, Martone WJ: Secular trends in nosocomial primary bloodstream infections in the United States, 1980–1989. American Journal of Medicine 1991, 91, Supplement 3B: 86–89.Google Scholar
  9. 9.
    Harvey RL, Meyers JP: Nosocomial fungemia in a large community teaching hospital. Archives of Internal Medicine 1987, 147: 2117–2120.Google Scholar
  10. 10.
    Horan T, Culver D, Jarvis W, Emori G, Banerjee S, Martone W, Thornsberry C: Pathogens causing nosocomial infections: Preliminary data from the National Nosocomial Infections Surveillance System. Antimicrobic Newsletter 1988, 5: 65–67.Google Scholar
  11. 11.
    Odds FC:Candida infections: An overview. CRC Critical Reviews in Microbiology 1987, 15: 1–5.Google Scholar
  12. 12.
    Pfaller MA: NosocomialCandida infections. In: Doebbeling BN, Herwaldt LA, Nettleman MD, Pfaller MA, Wenzel RP (ed): Hospital-acquired infections: new challenges. The Upjohn Company, Kalamazoo, MI, 1991, p. 61–80.Google Scholar
  13. 13.
    Wey SB, Mori M, Pfaller MA, Woolson RF, Wenzel RP: Hospital acquired candidemia: the attributable mortality and excess length of stay. Archives of Internal Medicine 1988, 148: 2642–2645.Google Scholar
  14. 14.
    Bross J, Talbot GH, Maislin G, Hurwitz S: Risk factors for nosocomial candidemia: a case-control study in adults without leukemia. American Journal of Medicine 1989, 87: 614–619.Google Scholar
  15. 15.
    Karabinis A, Hill C, Leclercq B, Tancrede C, Baume D, Andremont A: Risk factors for candidemia in cancer patients: a case-control study. Journal of Clinical Microbiology 1988, 26: 429–432.Google Scholar
  16. 16.
    Komshian SV, Uwaydak AK, Sobel JD, Crane LR: Fungemia caused byCandida species andTorulopsis glabrata in the hospitalized patient: frequency, characteristic, and evaluation of factors influencing outcome. Reviews of Infectious Diseases 1989, 11: 379–390.Google Scholar
  17. 17.
    Prasad JR, Feller I, Thompson PD: A ten-year review ofCandida sepsis and mortality in burn patients. Surgery 1987, 101: 213–216.Google Scholar
  18. 18.
    Schwartz RS, Mackintosh FR, Schrier SL, Greenberg PL: Multivariate analysis of factors associated with invasive fungal disease during remission-induction therapy for acute myelogenous leukemia. Cancer 1984, 53: 411–419.Google Scholar
  19. 19.
    Weese-Mayer DE, Fondries DW, Brouillette RT, Shulmas ST: Risk factors associated with candidemia in the neonatal intensive care unit: a case-control study. Pediatric Infectious Disease Journal 1987, 6: 190–196.Google Scholar
  20. 20.
    Wey SB, Mori M, Pfaller MA, Woolson RF, Wenzel RP: Risk factors for hospital acquired candidemia: a matched case-control study. Archives of Internal Medicine 1989, 149: 2349–2353.Google Scholar
  21. 21.
    Wiley JM, Smith N, Leventhal BG, Graham ML, Strauss LC, Hurwitz CA, Modlin J, Mellits D, Baumgardner R, Corden BJ, Civin CI: Invasive fungal disease in pediatric acute leukemia patients with fever and neutropenia during induction chemotherapy: a multivariate analysis of risk factors. Journal of Clinical Oncology 1990, 8: 280–286.Google Scholar
  22. 22.
    Tollemar J, Ringdën O, Boström L, Nilsson B, Sundberg B: Variables predicting deep fungal infections in bone marrow transplant recipients. Bone Marrow Transplantation 1989, 4: 635–641.Google Scholar
  23. 23.
    Miller PF, Wenzel RP: Etiologic organisms as independent predictors of death and morbidity associated with blood-stream infections. Journal of Infectious Diseases 1987, 156: 471–477.Google Scholar
  24. 24.
    Pannuti CS, Gingrich RD, Pfaller MA, Wenzel RP: Nosocomial pneumonia in adult patients undergoing bone marrow transplantation: A 9-year study. Journal of Clinical Oncology 1991, 9: 1–5.Google Scholar
  25. 25.
    Brody H, Carbon J: Electrophoretic karyotpye ofAspergillus nidulans. Proceedings of the National Academy of Sciences of the USA 1989, 86: 6260–6263.Google Scholar
  26. 26.
    Denning DW, Clemons KV, Hanson LH, Stevens DA: Restriction endonuclease analysis of total cellular DNA ofAspergillus fumigatus isolates of geographically and epidemiologically diverse origin. Journal of Infectious Diseases 1990, 162: 1151–1158.Google Scholar
  27. 27.
    Doebbeling BN, Hollis RJ, Isenberg HD, Wenzel RP, Pfaller MA: Restriction fragment analysis of aCandida tropicalis outbreak of sternal wound infections. Journal of Clinical Microbiology 1991, 29: 1268–1270.Google Scholar
  28. 28.
    Falkiner FR: Epidemiological typing: A user's view. Journal of Hospital Infections 1988, 11: 303–309.Google Scholar
  29. 29.
    Howell SA, Noble WC: Typing tools for the investigation of epidemic fungal infection. Epidemiology and Infection 1990, 105: 1–9.Google Scholar
  30. 30.
    Matthews R, Burnie J: Assessment of DNA finger-printing for rapid identification of outbreaks of systemic candidiasis. British Medical Journal 1989, 298: 354–357.Google Scholar
  31. 31.
    Merz WG, Connelly C, Hieter P: Variation of electrophoretic karyotypes among clinical isolates ofCandida albicans. Journal of Clinical Microbiology 1988, 26: 842–845.Google Scholar
  32. 32.
    Pfaller MA, Cabezudo I, Hollis R, Huston B, Wenzel RP: The use of biotyping and DNA fingerprinting in typingCandida albicans from hospitalized patients. Diagnostic Microbiology and Infectious Disease 1990, 13: 481–489.Google Scholar
  33. 33.
    Pfaller MA: Typing methods for epidemiologic investigation. In: Balows A, Hausler WJ, Herrmann K, Isenberg HD, Shadomy HJ (ed): Manual of clinical microbiology. American Society for Microbiology 1991, p. 171–182.Google Scholar
  34. 34.
    Pfaller MA: Epidemiological typing for mycoses. Clinical Infectious Diseases 1992, 14, Supplement 1: 4–10.Google Scholar
  35. 35.
    Polacheck I, Lebens GA: Electrophoretic karyotype of the pathogenic yeastCryptococcus neoformans. Journal of General Microbiology 1989, 135: 65–71.Google Scholar
  36. 36.
    Reagan DR, Pfaller MA, Hollis RJ, Wenzel RP: Characterization of the sequence of colonization and nosocomial candidemia using DNA fingerprinting and a DNA probe. Journal of Clinical Microbiology 1990, 28: 2733–2738.Google Scholar
  37. 37.
    Stevens DA, Odds FC, Scherer S: Applications of DNA typing methods toCandida albicans epidemiology and correlations with phenotype. Reviews of Infectious Diseases 1990, 12: 258–266.Google Scholar
  38. 38.
    Vaudry WL, Tierney AJ, Wenman WM: Investigation of a cluster of systemicCandida albicans infections in a neonatal intensive care unit. Journal of Infectious Diseases 1988, 158: 1375–1379.Google Scholar
  39. 39.
    Doebbeling BN, Pfaller MA, Houston AK, Wenzel RP: Removal of nosocomial pathogens from the contaminated glove: implications for glove reuse and handwashing. Annals of Internal Medicine 1988, 109: 394–398.Google Scholar
  40. 40.
    Fromtling RA: Overview of medically important antifungal azole derivatives. Clinical Microbiology Reviews 1988, 1: 187–217.Google Scholar
  41. 41.
    Walsh TJ, Pizzo A: Treatment of systemic fungal infections: recent progress and current problems. European Journal of Clinical Microbiology and Infectious Diseases 1988, 7: 460–475.Google Scholar
  42. 42.
    Walsh TJ, Jarosinski PF, Fromtling RA: Increasing usage of systemic antifungal agents. Diagnostic Microbiology and Infectious Disease 1990, 13: 37.Google Scholar
  43. 43.
    Pfaller MA, Rinaldi MG, Galgiani JN, Bartlett MS, Body BA, Espinel-Ingroff A, Fromtling RA, Hall GS, Hughs CE, Odds FC, Sugar AM: Collaborative investigation of variables in antifungal susceptibility testing of yeasts. Antimicrobial Agents and Chemotherapy 1990, 34: 1648–1654.Google Scholar
  44. 44.
    Pfaller MA: Antifungal susceptibility testing: in vitro and in vivo. In: Yamaguchi H, Kobayashi GS, Takahashi H (ed): Recent Progress in Antifungal Chemotherapy. Marcel Dekker, New York, 1991, p. 415–426.Google Scholar
  45. 45.
    Dick JD, Merz WG, Saral R: Incidence of polyene-resistant yeasts recovered from clinical specimens. Antimicrobial Agents and Chemotherapy 1980, 18: 158–163.Google Scholar
  46. 46.
    Hadfield TL, Smith MB, Winn RE, Rinaldi MG, Guerra C: Mycoses caused byCandida lusitaniae. Reviews of Infectious Diseases 1987, 9: 1006–1012.Google Scholar
  47. 47.
    McIlroy MA: Failure of fluconazole to suppress fungemia in a patient with fever, neutropenia, and typhlitis. Journal of Infectious Diseases 1991, 163: 420–421.Google Scholar
  48. 48.
    Warnock DW, Burke J, Cope NJ, Johnson EM, von Fraunhofer NA, Williams EW: Fluconazole resistance inCandida glabrata. Lancet 1988, ii: 1310.Google Scholar
  49. 49.
    Wingard JR, Merz WG, Rinaldi MG, Johnson TR, Karp JE, Saral R: Increase inCandida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole. New England Journal of Medicine 1991, 325: 1274–1277.Google Scholar

Copyright information

© Friedr. Vieweg & Sohn Verlagsgesellschaft mbH 1992

Authors and Affiliations

  • M. Pfaller
    • 1
  • R. Wenzel
    • 2
  1. 1.Department of Pathology, L471Oregon Health Sciences UniversityPortlandUSA
  2. 2.Division of General Medicine, Clinical Epidemiology and Health Services Research, Department of Internal MedicineUniversity of Iowa Hospitals and ClinicsIowa CityUSA

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