The epidemiology of fungaemia at the University Hospital of the West Indies, Kingston, Jamaica.

OBJECTIVES

To determine the epidemiology of fungaemia at the University Hospital of the West Indies (UHWI) as well as the incidence of fungaemia at the UHWI over a four-year period.

METHODS

A cross-sectional survey was conducted over a one-year period (2002). The RapID Yeast Plus Panel Identification kit was used to identify the yeasts found in blood while morphology and dimorphism were used to identify the single mold isolated, Histoplasma capsulatum. In addition, a retrospective review of the number of cases of fungaemia at the UHWI over a four-year period from 1998 was done using the laboratory and clinical records in order to determine the incidence over this period.

RESULTS

The study showed that Yeast not C albicans (YNCA) accounted for 47% of the isolates while Candida albicans accounted for 29%. Of the YNCA species, Candida tropicalis was the most common (75%), followed by C pseudotropicalis (12.5%) and C glabrata (12.5%). Cryptococcus sp accounted for 18% of all fungal isolates and there was one isolate (6%) of Histoplasma capsulatum. The medical wards had the most isolates (47%), followed by surgery (29%) and the Intensive Care Unit (ICU) [24%]. While the rate at which fungi were isolated from the blood remained constant over 1998, 1999 and 2001, this doubled in 2002 from 0.26% to 0.5%.

CONCLUSION

Although the incidence of fungaemia at the UHWI has remained relatively low, there was a marked increase in the last year of the study (2002) with a doubling of the number of positive fungal cultures. Candida species account for most cases of fungaemia at the UHWI. However non-albicans Candida spp were more commonly isolated than C albicans, a trend that needs to be monitored because of its implications for therapy.