Nosocomial Bloodstream Candida Infections in a Tertiary-Care Hospital in South Brazil: A 4-Year Survey

Abstract

The aims of this study were to evaluate the epidemiology of nosocomial candidemia in a tertiary hospital in South Brazil and the in vitro antifungal susceptibility of isolates. Blood strains from 108 patients were identified by PCR-based method. Some 30.5 % of candidemia were caused by Candida tropicalis, 28.7 % were due to Candida albicans, 24.1 % with Candida parapsilosis sensu stricto, 8.3 % with Candida glabrata sensu lato, 1.8 % involved Candida krusei and 6.6 % with other species. Candidemia was more common in intensive care unit settings (66 %). In vitro susceptibility to antifungal drugs was determined by a microdilution method; and new species-specific clinical breakpoints for fluconazole and voriconazole were applied. Overall susceptibility rates were 100 % for itraconazole, 91 % for fluconazole, 98 % for voriconazole and 99 % for amphotericin B. Fluconazole resistance was mostly among C. parapsilosis sensu stricto isolates (26.9 %). Most of the findings reported here agreed with epidemiological features common to other tertiary hospitals in Brazil; but also revealed some peculiarities, such as a high frequency of C. tropicalis associated with candidemia. Besides, high rate of fluconazole resistance among C. parapsilosis stricto sensu isolates was obtained when applying the new species-specific clinical breakpoints.

The Relative Frequency and Susceptibility Patterns of Candida Species Isolated from Blood and Urine of Children with Malignancy

“…Candida albicans was the most prevalent species isolated from the samples in our study, which is consistent with other studies (1,(15)(16)(17). In this study, the rates of nonCandida albicans were C. tropicalis 16 (15.7%), C. parapsilosis 9.8%, C. kefyr 9.8%, C. famata 3.9%, and C. dubliniensis 2%.…”

“…Candida albicans is a more frequent isolate, but in recent years, the incidence of non-albicans Candida species like Candida krusei, Candida glabrata, Candida kefyr, Candida parapsilosis, and Candida tropicalis has increased significantly (4). The incidence rate of the fungal infection in pediatric patients with hematologic disorders was reported 16.3% and C. albicans was the most prevalent etiologic agent (5). In neonates, Candida colonization was reported in ear, umbilicus, rectum, catheter, and tracheal tube and it is related to the risk of developing a systemic candidiasis (6).…”

Phenotypic switching ofCandida tropicalisis associated with cell damage in epithelial cells and virulence inGalleria mellonellamodel

“…tropicalis together with the majority of the medically relevant Candida species belongs to the CTG clade and is genetically close to C. albicans. The frequency of infections caused by C. tropicalis has increased over the last years, particularly in tropical regions; [11][12][13] in some settings, bloodstream infections due to C. tropicalis have been associated with higher mortality than other Candida species. 14,15 In the present study, we address for the first time in the literature, if phenotypic switching affects virulence in C. tropicalis.…”

Comparação do sistema de identificação automatizado Vitek 2 e PCR-ITS para caracterização das espécies dos isolados clínicos de Candida spp.

“…Os dados são numericamente bastante confortáveis, porém, da mesma forma, preocupantes, uma vez que observamos mais da metade (54,6%) das candidemias diagnosticadas em nosso hospital sendo causadas por C. tropicalis e C. parapsilosis (COSTA et al, 2014).…”

“…em infecções invasivas assim como a participação de espécies não albicans em infecções severas no Hospital Universitário de Londrina (COSTA et al, 2014), trouxe a necessidade de se estabelecer uma rotina que caracterize as diferentes espécies, aliando qualidade à praticidade e à rapidez no diagnóstico.…”