Is the incidence of candidemia caused byCandida glabrataincreasing in Brazil? Five-year surveillance ofCandidabloodstream infection in a university reference hospital in southeast Brazil

Abstract

From 2006 to 2010, a retrospective study was conducted in a university referral tertiary care hospital to study the frequency and distribution of Candida species in different medical specialties. The use of mechanical ventilation, central venous catheter, and urinary catheter were recorded per 1,000 patient-days and the use of antifungals was calculated using defined daily dose (DDD). A total of 313 episodes were identified and the overall incidence was 0.54 (0.41-0.71) episodes per 1,000 patient-days. Candida albicans caused 44% of the overall episodes, followed by C. tropicalis (21.7%), C. parapsilosis (14.4%), C. glabrata (11.2%), and C. krusei (3.5%). The incidence of C. glabrata significantly increased from 2006-2010 (range: 4.8-23.5%) (P = 0.024). Candida glabrata was associated with malignancies (P = 0.004) and C. krusei with hematologic malignancies (P < 0.0001). The use of antifungals was higher in the hematology/bone marrow transplant units and represented 40% of all fluconazole prescription in the hospital. There was no correlation with the use of fluconazole and the increasing ratio of C. glabrata (r = 0.60). The use of invasive devices was significantly higher in the intensive care units (ICUs) than the medical and surgical emergencies units (P < 0.001). In contrast, the emergencies had higher incidence of candidemia (2-2.1 episodes/1,000 patient-days) than the ICUs (1.6 episodes 1,000 patient-days). Candida glabrata candidemia showed a significant increase in contrast to the current national literature where C. parapsilosis remained the most important non-C. albicans Candida species in Brazilian hospitals. Our findings suggested that the increasing incidence of C. glabrata was not associated with use of fluconazole and other risk factors might play an important role.

Significance of yeasts in bloodstream infection: Epidemiology and predisposing factors of Candidaemia in adult patients at a university hospital (2010–2014)

“…albicans was the most frequently isolated species (63%), and the percentage of C. albicans isolates per year did not change signifi cantly during the study period. Several studies have detected a shift towards non-albicans Candida spp., especially C. glabrata, causing BSI [23]. This trend was observed at our institute as well, with the number of non-albicans isolates increasing steadily from 2010 to 2014.…”

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

“…were isolated between 2011 and 2013: Candida kefyr, Candida krusei and Fusarium sp. Recent isolation of C. glabrata can represent a trend of increased incidence of this species in Brazil, already reported in São Paulo between 2006 and 2010, 32 whose mortality seems higher than that of C. albicans. 3 An interesting fact is the increased prevalence of genera other than Candida, whose mortality rate is higher than that found in candidemias.…”

Invasive candidosis: contrasting the perceptions of infectious disease physicians and intensive care physicians

“…For instance, more than half of the participants declared that the frequency of candidemia caused by Candida species other than Candida albicans was lower than 10%; the actual proportion reported in most studies varies from 40% to 74% 8 . Additionally, more than 90% of the physicians were not aware of the increase of C. glabrata incidence that has been documented in some medical centers in Brazil 7,14,15 . As shown in Table 1, misunderstanding of the epidemiology of candidemia was particularly common among the ICU physicians.…”