Evaluation of Candida bloodstream infection and antifungal utilization in a tertiary care hospital

Tatiana Aporta Marins; Alexandre R Marra; Michael B Edmond; Marines Dalla Valle Martino; Paula Kiyomi Onaga Yokota; Ana Carolina Cintra Nunes Mafra; Marcelino Souza Durão Jr

doi:10.1186/s12879-018-3094-9

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Evaluation of Candida bloodstream infection and antifungal utilization in a tertiary care hospital

Journal article

Open access

Peer reviewed

Evaluation of Candida bloodstream infection and antifungal utilization in a tertiary care hospital

Tatiana Aporta Marins, Alexandre R Marra, Michael B Edmond, Marines Dalla Valle Martino, Paula Kiyomi Onaga Yokota, Ana Carolina Cintra Nunes Mafra and Marcelino Souza Durão Jr

BMC infectious diseases, Vol.18(1), 187

04/18/2018

DOI: 10.1186/s12879-018-3094-9

PMCID: PMC5907302

PMID: 29669521

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Abstract

Candida bloodstream infections carry a significant mortality risk, justifying the importance of adequate antifungal therapy. This study describes trends in antifungal consumption using the Defined Daily Dose (DDD) and Days of Therapy (DOT) metrics, identifies the microbiological profile, the time to initiation of empirical therapy, the adjustment after positive blood culture results for Candida, and the impact on in-hospital mortality rate in patients with candidemia. An analysis of antifungal consumption from 2008 to 2016, and of candidemia cases from 2012 to 2016 was carried out in a private tertiary hospital. A total of 11,273 admissions were identified with a prescription for at least one type of antifungal therapy. Fluconazole was the most prescribed antifungal drug in terms of general consumption. Through the DDD and DOT metrics, we observed that over time, there was an increase in the consumption of liposomal amphotericin B, micafungin and voriconazole. Candida albicans was the most isolated species in blood cultures. Regarding candidemia, we analyzed samples from 115 patients. Empirical therapy was started within 24 h of blood culture in 44.3% of the cases, and in 81.7% of the cases, the antifungal was deemed to be adequate based in antifungal susceptibility testing, both of which were not associated with the in-hospital mortality rate. Our study reinforces the importance of monitoring the consumption of antifungal agents, which helps in proposing actions that lead to their rational use and, consequently, reduces the appearance of resistant strains.

Length of Stay

Blood Culture

Hospital Mortality

Humans

Middle Aged

Male

Candidemia - mortality

Candidemia - epidemiology

Candida - isolation & purification

Antifungal Agents - therapeutic use

Tertiary Care Centers - statistics & numerical data

Candida - pathogenicity

Candidemia - drug therapy

Candidiasis - drug therapy

Aged, 80 and over

Female

Aged

Brazil - epidemiology

Details

Title: Subtitle: Evaluation of Candida bloodstream infection and antifungal utilization in a tertiary care hospital
Creators: Tatiana Aporta Marins - Hospital Israelita Albert Einstein, São Paulo, Brazil. tatiana.marins@einstein.br
Alexandre R Marra - Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Michael B Edmond - Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Marines Dalla Valle Martino - Clinical Laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil
Paula Kiyomi Onaga Yokota - Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
Ana Carolina Cintra Nunes Mafra - Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
Marcelino Souza Durão Jr - Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
Resource Type: Journal article
Publication Details: BMC infectious diseases, Vol.18(1), 187
DOI: 10.1186/s12879-018-3094-9
PMID: 29669521
PMCID: PMC5907302
NLM abbreviation: BMC Infect Dis
ISSN: 1471-2334
eISSN: 1471-2334
Publisher: England
Language: English
Date published: 04/18/2018
Academic Unit: Internal Medicine
Record Identifier: 9983905648002771

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