title: Prevalence, susceptibility profile for fluconazole and risk factors for candidemia in a tertiary care hospital in southern Brazil.
abstract: Bloodstream infections caused by yeast, Candida spp, are quite important clinically and epidemiologically due to a high mortality rate and an increasing number of non-albicans species with a more resistant (differentiated susceptibility) profile. We examined species prevalence and susceptibility profile for fluconazole and the risk for nosocomial infections by Candida spp at the Hospital de Clínicas de Porto Alegre, a general tertiary care hospital in southern Brazilian, through a retrospective study, beginning with positive cultures of hospitalized patients. The distribution by species in 131 documented episodes was as follows: Candida albicans (45%), C. parapsilosis (24.4%), C. tropicalis (15.3%), C. glabrata (6.9%), C. krusei (4.6%) and 3.8% other species (C. pelicullosa, C. guilliermondii, C. lusitaniae and C. kefyr). The vast majority of samples (121- 92.4%) were susceptible to fluconazole; the resistant or dose-dependent sensitive samples included only C. krusei and C. glabrata. Blood diseases (leukemia, lymphoma), or neoplasias (solid tumors), were found in 35.0% of the candidemia episodes. We noted the previous use of antibiotics in 128 (97.7%) patients, with 79.7% using three or more antibiotics before the candidemia episode. Other risk factors included a central venous catheter in 94 (71.8%) and abdominal surgery in 32 (24.4%) patients. The overall mortality rate was 51.9%, which varied according to the underlying disease. We found that C. albicans was the most prevalent species, although the non-albicans species predominated. However, in vitro resistance to fluconazole was detected only among the species (C. glabrata and C. krusei) that tend to be resistant to the azolic compounds. Previous use of antibiotic and the use of a central venous catheter were the main risk factors among patients with candidemia.
authors.affiliation: Microbiology Unit, Section of Clinical Pathology, Clinical Hospital of Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil. vaquino@hcpa.ufrgs.br
authors.forename: Valério Rodrigues
authors.initials: VR
authors.lastname: Aquino
authors.forename: Luciano W
authors.initials: LW
authors.lastname: Lunardi
authors.forename: Luciano Zubaran
authors.initials: LZ
authors.lastname: Goldani
authors.forename: Afonso Luis
authors.initials: AL
authors.lastname: Barth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D002175:Candida / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D003428:Cross Infection / Q000453:epidemiology*; D025141:Drug Resistance, Fungal; D004812:Epidemiologic Methods; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole