Nosocomial Candidemia (NC) and antibiotic usage in 4 medical school affiliated hospitals

During 1996 we performed comprehensive surveillance for all cases of candidemia in the 4 teaching hospitals affiliated with Baylor College of Medicine. It became apparent that the two private hospitals had higher rates of NC (14 and 15 / 10,000 pt. days) than that of the public hospitals (3 and 7 /10,000 pt. days). We hypothesized this was due to differences in antibiotic formularies and prescribing practices among the 4 hospitals, including the use of restricted formularies at the public hospitals vs. none at the private hospitals. Greater than 75% of the NC were seen at the private hospitals. APACHE scores on culture day and NC risk factors two weeks prior to positive culture were not significantly different between patients in the 4 hospitals. Drug Class Gms/1000 Patient Days Private Public % Difference Aminoglycosides 39.20 25.35 35.34 Penicillins 1288.66 1651.08 -28.12 Cephalosporins 1012.71 541.35 46.54 Quinolones 167.28 231.48 -38.38 Carbapenems 59.73 32.40 45.75 Vancomycin 365.39 68.300 81.31 Others 408.23 579.82 -42.03 Total 3341.20 3129.78 6.33 Of all drug classes only the amount of cephalosporins used/1000 pt. days was significantly correlated with NC (p < 0.01).