Epidemiology of Candidemia in Brazil: a Nationwide Sentinel Surveillance of Candidemia in Eleven Medical Centers

Abstract

Candidemia studies have documented geographic differences in rates and epidemiology, underscoring the need for surveillance to monitor trends. We conducted prospective candidemia surveillance in Brazil to assess the incidence, species distribution, frequency of antifungal resistance, and risk factors for fluconazole-resistant Candida species. Prospective laboratory-based surveillance was conducted from March 2003 to December 2004 in 11 medical centers located in 9 major Brazilian cities. A case of candidemia was defined as the isolation of Candida spp. from a blood culture. Incidence rates were calculated per 1,000 admissions and 1,000 patientdays. Antifungal susceptibility tests were performed by using the broth microdilution assay, according to the Clinical and Laboratory Standards Institute guidelines. We detected 712 cases, for an overall incidence of 2.49 cases per 1,000 admissions and 0.37 cases per 1,000 patient-days. The 30-day crude mortality was 54%. C. albicans was the most common species (40.9%), followed by C. tropicalis (20.9%) and C. parapsilosis (20.5%). Overall, decreased susceptibility to fluconazole occurred in 33 (5%) of incident isolates, 6 (1%) of which were resistant. There was a linear correlation between fluconazole and voriconazole MICs (r ‫؍‬ 0.54 and P < 0.001 [Spearman's rho]). This is the largest multicenter candidemia study conducted in Latin America and shows the substantial morbidity and mortality of candidemia in Brazil. Antifungal resistance was rare, but correlation between fluconazole and voriconazole MICs suggests cross-resistance may occur.

Candidemia em hospital terciário do nordeste do Brasil

“…Nessa casuística, as espécies não-albicans foram mais freqüentes que Candida albicans, e destas, Candida parapsilosis (nº=7) foi a mais encontrada, seguida da Candida tropicalis (nº=5). Apesar dos números pequenos, e do caráter unicêntrico deste estudo, os dados encontrados estão de acordo com o estudo epidemiológico brasileiro que demonstrou que Candida albicans, Candida parapsilosis e Candida tropicalis causam a maioria das candidemias 9 . Embora tenha sido observada uma maior proporção de candidemia por Candida glabrata (9%) comparado com os dados brasileiros 9 , o número pequeno da candidemias não permite uma conclusão definitiva.…”

“…Apesar dos números pequenos, e do caráter unicêntrico deste estudo, os dados encontrados estão de acordo com o estudo epidemiológico brasileiro que demonstrou que Candida albicans, Candida parapsilosis e Candida tropicalis causam a maioria das candidemias 9 . Embora tenha sido observada uma maior proporção de candidemia por Candida glabrata (9%) comparado com os dados brasileiros 9 , o número pequeno da candidemias não permite uma conclusão definitiva. A epidemiologia de candidemia em centros do Nordeste brasileiro não é ainda muito conhecida 5 .…”

“…Esta droga é uma das opções terapêuticas de candidemia, como relatado em estudo randomizado, recentemente publicado 12 . Estes dados não refletem a realidade dos principais hospitais públicos brasileiros, onde anfotericina B desoxicolato e fluconazol respondem pela maioria dos tratamentos primários de candidemia 9 .…”

Candida parapsilosis complex water isolates from a haemodialysis unit: biofilm production and in vitro evaluation of the use of clinical antifungals

“…It is particularly important in dialysis to prevent the formation of biofilm, because the reduced availability of nutrients and accumulation of toxic waste encourages the dispersal of cells, i.e., the release of cells from the original biofilm community to generate new communities in new places (Uppuluri et al 2010). Dispersed cells of Candida are responsible for candidemia and invasive disseminated candidiasis, which are among the most serious forms of infection and lead to the highest mortality rates (Colombo et al 2006, Bruder-Nascimento et al 2010. Isolates with MBIC n-folds higher than the MIC n (%) a: MIC amphotericin B = 2 µg/mL (Clinical and Laboratory Standards Institute M27-A3 document) (Guinea et al 2010).…”

“…Previous studies, which compared the clinical use of drugs such as fluconazole (FLC) and amphotericin B (AMB) showed that FLC is the best therapy in the empiric treatment of fungal infections due to lower toxicity and low cost (Pfaller et al 2003, Colombo et al 2006, Nucci et al 2010.…”