Candidemia in a brazilian tertiary hospital: microbiological and clinical features over a six-year period

Abstract

Abstract:Yeasts are becoming a common cause of nosocomial fungal infections in immunocompromised patients. Such infections often develop into sepsis with high mortality rates. The aim of this study was to evaluate some of the numerous factors associated with the development of candidemia. Medical records were retrospectively analyzed of 98 Candida spp. patients. Results showed that the most prevalent risk factors for developing candidemia were: antibiotics and antifungal agents (93.9% and 79.6%, respectively); the use of central venous catheter (93.9%); mechanical ventilation (73.5%); and parenteral nutrition (60.2%). The main species of Candida found were: C. parapsilosis (37.76%), C. albicans (33.67%); and others (28.57%). C. glabrata showed the highest mortality rate (75%), followed by C. tropicalis (57.1%) and C. albicans (54.5%). The elevated mortality rate found in this study indicates that preventive measures against candidemia must be emphasized in hospitals.Key words: candidemia, mortality, associated factors, Candida albicans. Original PaPer The Journal of Venomous Animals and Toxins including Tropical Diseases ISSN 1678-9199 | 2012 | volume 18 | issue 2 | pages 244-252 INTRODUCTIONSeveral authors have reported a global increase in yeast infections over the past 20 years. Candida species can be found in the gastrointestinal tract of 20 to 80% of healthy adults, becoming pathogenic when host immune conditions are altered by offending factors (1). Of the invasive infections caused by Candida spp., blood infections, also known as candidemias, are the most clinically relevant (2). Candida spp. is currently one of the five main causes of blood infections in hospitals, and an increase in candidemia cases has been reported mainly in patients using antibiotics, under immunosuppressive therapy or parenteral nutrition, and in patients exposed to multiple invasive procedures (3,4). Candidemia is one of the most common blood infections in tertiary hospitals; it has also been associated with long stay in hospitals and high mortality (5-8).Although Candida albicans is the most frequent species isolated in patients with fungemia, cases of infections caused by other Candida species have increased (9-15). The frequency of C. albicans and other Candida species found in patients depends, among other factors, on the analyzed population and used therapy (16)(17)(18)(19). The most commonly found species in Brazilian candidemia patients are C. albicans, Candida parapsilosis, and Candida tropicalis (20). MATERIALS AND METHODSWe analyzed 98 yeast samples from different patients admitted to Botucatu Medical School University Hospital (HC-FMB) between 2000 and 2006 along with their medical records (obtained from the Statistical Medical Service -SAME, owned by HC-FMB). These patients developed symptoms of candidemia and samples were Sample size was calculated using the Fisher and Belle formula, with a 95% confidence interval and 5% precision for expected prevalence of fungemia patients. Beck-Sagué and Jarvis (21) study was used a...

Candidiasis sistémica en pacientes críticos, factores predictores de riesgo

“…La atención en salud está relacionada a la aparición de infecciones por Candida, secundaria al uso de dispositivos invasivos, antibióticos de amplio espectro y nutrición parenteral (40) . Los factores de riesgo para infecciones micóticas en paciente críticamente enfermo son quimioterapia, radioterapia, corticosteroides, inmunosupresión uso reciente o recurrente de antibióticos, colonización micótica, malnutrición, estancia prolongada en UCI, sepsis y puntaje elevado en la escala de APACHE, entre otros (2) .…”

“…Estudios clínicos y consensos de expertos como la IDSA (Infectious Disease Society of America), entre otros, han propuesto como manejo de primera elección el uso del fluconazol, seguido de equinocandinas, especialmente la caspofungina (2,20,22,68) . Además, se ha mostrado en múltiples estudios una disminución en la mortalidad por candidemia cuando se ha utilizado manejo profiláctico en los pacientes críticos internados en la unidad de cuidados intensivos (2,20,40,56,69) . (12) , De Luca 2012 (15) , Cortés 2012 Almeida 2013 (12) , Giri 2012 (11) , Nucci 2013 (35) , Cortés 2012 (36) C. glabrata Caspofungina 50 mg/día 70 mg dosis inicial Limitados…”