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Epidemiology and Microbiologic Characterization of Nosocomial Candidemia from a Brazilian National Surveillance Program

Candidemia is a growing problem in hospitals all over the world. Despite advances in the medical support of critically ill patients, candidiasis leads to prolonged hospitalization, and has a crude mortality rate around 50%. We conducted a multicenter surveillance study in 16 hospitals distributed ac...

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Autores principales: Doi, André Mario, Pignatari, Antonio Carlos Campos, Edmond, Michael B., Marra, Alexandre Rodrigues, Camargo, Luis Fernando Aranha, Siqueira, Ricardo Andreotti, da Mota, Vivian Pereira, Colombo, Arnaldo Lopes
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4726651/
https://www.ncbi.nlm.nih.gov/pubmed/26808778
http://dx.doi.org/10.1371/journal.pone.0146909
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author Doi, André Mario
Pignatari, Antonio Carlos Campos
Edmond, Michael B.
Marra, Alexandre Rodrigues
Camargo, Luis Fernando Aranha
Siqueira, Ricardo Andreotti
da Mota, Vivian Pereira
Colombo, Arnaldo Lopes
author_facet Doi, André Mario
Pignatari, Antonio Carlos Campos
Edmond, Michael B.
Marra, Alexandre Rodrigues
Camargo, Luis Fernando Aranha
Siqueira, Ricardo Andreotti
da Mota, Vivian Pereira
Colombo, Arnaldo Lopes
author_sort Doi, André Mario
collection PubMed
description Candidemia is a growing problem in hospitals all over the world. Despite advances in the medical support of critically ill patients, candidiasis leads to prolonged hospitalization, and has a crude mortality rate around 50%. We conducted a multicenter surveillance study in 16 hospitals distributed across five regions of Brazil to assess the incidence, species distribution, antifungal susceptibility, and risk factors for bloodstream infections due to Candida species. From June 2007 to March 2010, we studied a total of 2,563 nosocomial bloodstream infection (nBSI) episodes. Candida spp. was the 7(th) most prevalent agent. Most of the patients were male, with a median age of 56 years. A total of 64 patients (46.7%) were in the ICU when candidemia occurred. Malignancies were the most common underlying condition (32%). The crude mortality rate of candidemia during the hospital admission was 72.2%. Non-albicans species of Candida accounted for 65.7% of the 137 yeast isolates. C. albicans (34.3%), Candida parapsilosis (24.1%), Candida tropicalis (15.3%) and Candida glabrata (10.2%) were the most prevalent species. Only 47 out of 137 Candida isolates were sent to the reference laboratory for antifungal susceptibility testing. All C. albicans, C. tropicalis and C. parapsilosis isolates were susceptible to the 5 antifungal drugs tested. Among 11 C. glabrata isolates, 36% were resistant to fluconazole, and 64% SDD. All of them were susceptible to anidulafungin and amphotericin B. We observed that C. glabrata is emerging as a major player among non-albicans Candida spp. and fluconazole resistance was primarily confined to C. glabrata and C. krusei strains. Candida resistance to echinocandins and amphotericin B remains rare in Brazil. Mortality rates remain increasingly higher than that observed in the Northern Hemisphere countries, emphasizing the need for improving local practices of clinical management of candidemia, including early diagnosis, source control and precise antifungal therapy.
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spelling pubmed-47266512016-02-03 Epidemiology and Microbiologic Characterization of Nosocomial Candidemia from a Brazilian National Surveillance Program Doi, André Mario Pignatari, Antonio Carlos Campos Edmond, Michael B. Marra, Alexandre Rodrigues Camargo, Luis Fernando Aranha Siqueira, Ricardo Andreotti da Mota, Vivian Pereira Colombo, Arnaldo Lopes PLoS One Research Article Candidemia is a growing problem in hospitals all over the world. Despite advances in the medical support of critically ill patients, candidiasis leads to prolonged hospitalization, and has a crude mortality rate around 50%. We conducted a multicenter surveillance study in 16 hospitals distributed across five regions of Brazil to assess the incidence, species distribution, antifungal susceptibility, and risk factors for bloodstream infections due to Candida species. From June 2007 to March 2010, we studied a total of 2,563 nosocomial bloodstream infection (nBSI) episodes. Candida spp. was the 7(th) most prevalent agent. Most of the patients were male, with a median age of 56 years. A total of 64 patients (46.7%) were in the ICU when candidemia occurred. Malignancies were the most common underlying condition (32%). The crude mortality rate of candidemia during the hospital admission was 72.2%. Non-albicans species of Candida accounted for 65.7% of the 137 yeast isolates. C. albicans (34.3%), Candida parapsilosis (24.1%), Candida tropicalis (15.3%) and Candida glabrata (10.2%) were the most prevalent species. Only 47 out of 137 Candida isolates were sent to the reference laboratory for antifungal susceptibility testing. All C. albicans, C. tropicalis and C. parapsilosis isolates were susceptible to the 5 antifungal drugs tested. Among 11 C. glabrata isolates, 36% were resistant to fluconazole, and 64% SDD. All of them were susceptible to anidulafungin and amphotericin B. We observed that C. glabrata is emerging as a major player among non-albicans Candida spp. and fluconazole resistance was primarily confined to C. glabrata and C. krusei strains. Candida resistance to echinocandins and amphotericin B remains rare in Brazil. Mortality rates remain increasingly higher than that observed in the Northern Hemisphere countries, emphasizing the need for improving local practices of clinical management of candidemia, including early diagnosis, source control and precise antifungal therapy. Public Library of Science 2016-01-25 /pmc/articles/PMC4726651/ /pubmed/26808778 http://dx.doi.org/10.1371/journal.pone.0146909 Text en © 2016 Doi et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Doi, André Mario
Pignatari, Antonio Carlos Campos
Edmond, Michael B.
Marra, Alexandre Rodrigues
Camargo, Luis Fernando Aranha
Siqueira, Ricardo Andreotti
da Mota, Vivian Pereira
Colombo, Arnaldo Lopes
Epidemiology and Microbiologic Characterization of Nosocomial Candidemia from a Brazilian National Surveillance Program
title Epidemiology and Microbiologic Characterization of Nosocomial Candidemia from a Brazilian National Surveillance Program
title_full Epidemiology and Microbiologic Characterization of Nosocomial Candidemia from a Brazilian National Surveillance Program
title_fullStr Epidemiology and Microbiologic Characterization of Nosocomial Candidemia from a Brazilian National Surveillance Program
title_full_unstemmed Epidemiology and Microbiologic Characterization of Nosocomial Candidemia from a Brazilian National Surveillance Program
title_short Epidemiology and Microbiologic Characterization of Nosocomial Candidemia from a Brazilian National Surveillance Program
title_sort epidemiology and microbiologic characterization of nosocomial candidemia from a brazilian national surveillance program
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4726651/
https://www.ncbi.nlm.nih.gov/pubmed/26808778
http://dx.doi.org/10.1371/journal.pone.0146909
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