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

André Mario Doi; Antonio Carlos Campos Pignatari; Michael B Edmond; Alexandre Rodrigues Marra; Luis Fernando Aranha Camargo; Ricardo Andreotti Siqueira; Vivian Pereira da Mota; Arnaldo Lopes Colombo

doi:10.1371/journal.pone.0146909

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

Journal article

Open access

Peer reviewed

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

André Mario Doi, Antonio Carlos Campos Pignatari, Michael B Edmond, Alexandre Rodrigues Marra, Luis Fernando Aranha Camargo, Ricardo Andreotti Siqueira, Vivian Pereira da Mota and Arnaldo Lopes Colombo

PloS one, Vol.11(1), e0146909

2016

DOI: 10.1371/journal.pone.0146909

PMCID: PMC4726651

PMID: 26808778

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Abstract

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 7th 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.

Candidemia - microbiology

Prevalence

Humans

Middle Aged

Risk Factors

Cross Infection - mortality

Male

Survival Rate

Candidemia - mortality

Candidemia - epidemiology

Candida - isolation & purification

Incidence

Cross Infection - microbiology

Sex Factors

Female

Drug Resistance, Fungal

Population Surveillance

Brazil - epidemiology

Cross Infection - epidemiology

Details

Title: Subtitle: Epidemiology and Microbiologic Characterization of Nosocomial Candidemia from a Brazilian National Surveillance Program
Creators: André Mario Doi - Department of Medicine, Division of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, SP, Brazil
Antonio Carlos Campos Pignatari - Department of Medicine, Division of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, SP, Brazil
Michael B Edmond - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
Alexandre Rodrigues Marra - Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
Luis Fernando Aranha Camargo - Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
Ricardo Andreotti Siqueira - Department of Medicine, Division of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, SP, Brazil
Vivian Pereira da Mota - Laboratório Central, Hospital São Paulo, São Paulo, SP, Brazil
Arnaldo Lopes Colombo - Department of Medicine, Division of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, SP, Brazil
Resource Type: Journal article
Publication Details: PloS one, Vol.11(1), e0146909
DOI: 10.1371/journal.pone.0146909
PMID: 26808778
PMCID: PMC4726651
NLM abbreviation: PLoS One
ISSN: 1932-6203
eISSN: 1932-6203
Publisher: United States
Language: English
Date published: 2016
Academic Unit: Internal Medicine
Record Identifier: 9983905647302771

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