Prevalence, susceptibility profile for fluconazole and risk factors for candidemia in a tertiary care hospital in southern Brazil

Abstract

Bloodstream infections caused by yeast, Candida spp, are quite important clinically and epidemiologically due to a high mortality rate and an increasing number of non-albicans species with a more resistant (differentiated susceptibility) profile. We examined species prevalence and susceptibility profile for fluconazole and the risk for nosocomial infections by Candida spp at the Hospital de Clínicas de Porto Alegre, a general tertiary care hospital in southern Brazilian, through a retrospective study, beginning with positive cultures of hospitalized patients. The distribution by species in 131 documented episodes was as follows: Candida albicans (45%), C. parapsilosis (24.4%), C. tropicalis (15.3%), C. glabrata (6.9%), C. krusei (4.6%) and 3.8% other species (C. pelicullosa, C. guilliermondii, C. lusitaniae and C. kefyr). The vast majority of samples (121- 92.4%) were susceptible to fluconazole; the resistant or dose-dependent sensitive samples included only C. krusei and C. glabrata. Blood diseases (leukemia, lymphoma), or neoplasias (solid tumors), were found in 35.0% of the candidemia episodes. We noted the previous use of antibiotics in 128 (97.7%) patients, with 79.7% using three or more antibiotics before the candidemia episode. Other risk factors included a central venous catheter in 94 (71.8%) and abdominal surgery in 32 (24.4%) patients. The overall mortality rate was 51.9%, which varied according to the underlying disease. We found that C. albicans was the most prevalent species, although the non-albicans species predominated. However, in vitro resistance to fluconazole was detected only among the species (C. glabrata and C. krusei) that tend to be resistant to the azolic compounds. Previous use of antibiotic and the use of a central venous catheter were the main risk factors among patients with candidemia.

Evaluation of Species Distribution and Antifungal Resistance of Candida Isolates From Hospitalized Patients

“…içinde en sık saptanan tür C. albicans olmakla birlikte bazı çalışmalarda ilk sırayı C. parapsilosis almaktadır [8][9][10]. Kandida türlerinin gö-rülme sıklıkları, çalışmanın yapıldığı hasta grubunun özellikleri-ne ve coğrafi bölgelere göre değişiklik göstermektedir [8][9][10][11]. Ülkemizden bildirilmiş kandida olgularında, çeşitli merkezlerden farklı oranlar (%37-65) bildirilmekle beraber genellikle C. albicans birinci sırada yer almaktadır [6,9,12] [13][14][15].…”

Candidemia epidemiology and susceptibility profile in the largest Brazilian teaching hospital complex

“…This fi nding is consistent with national and Latin American studies. 6,22,28,29 However, important differences of species distribution have been documented when evaluating by age group and clinical wards (nurses or ICU). Of note, C. parapsilosis was the most prevalent non-C. albicans species, probably because a high proportion of children younger than 1 year old accounted for almost 25% of cases.…”

Prevalence of fungemia in a tertiary hospital: Analysis of the last decade

“…28 C. glabrata has been associated with prior use of azoles, and transplants of solid organ and hematopoietic cells. 2,[29][30][31] Some Candida spp. were isolated between 2011 and 2013: Candida kefyr, Candida krusei and Fusarium sp.…”