title: Epidemiology of candidemia in Brazil: a nationwide sentinel surveillance of candidemia in eleven medical centers.
abstract: Candidemia studies have documented geographic differences in rates and epidemiology, underscoring the need for surveillance to monitor trends. We conducted prospective candidemia surveillance in Brazil to assess the incidence, species distribution, frequency of antifungal resistance, and risk factors for fluconazole-resistant Candida species. Prospective laboratory-based surveillance was conducted from March 2003 to December 2004 in 11 medical centers located in 9 major Brazilian cities. A case of candidemia was defined as the isolation of Candida spp. from a blood culture. Incidence rates were calculated per 1,000 admissions and 1,000 patient-days. Antifungal susceptibility tests were performed by using the broth microdilution assay, according to the Clinical and Laboratory Standards Institute guidelines. We detected 712 cases, for an overall incidence of 2.49 cases per 1,000 admissions and 0.37 cases per 1,000 patient-days. The 30-day crude mortality was 54%. C. albicans was the most common species (40.9%), followed by C. tropicalis (20.9%) and C. parapsilosis (20.5%). Overall, decreased susceptibility to fluconazole occurred in 33 (5%) of incident isolates, 6 (1%) of which were resistant. There was a linear correlation between fluconazole and voriconazole MICs (r = 0.54 and P < 0.001 [Spearman's rho]). This is the largest multicenter candidemia study conducted in Latin America and shows the substantial morbidity and mortality of candidemia in Brazil. Antifungal resistance was rare, but correlation between fluconazole and voriconazole MICs suggests cross-resistance may occur.
authors.affiliation: Division of Infectious Diseases, Universidade Federal de São Paulo, Rua Botucatu 740, 04023-062 São Paulo, Brazil. colomboal@terra.com.br.
authors.forename: Arnaldo L
authors.initials: AL
authors.lastname: Colombo
authors.forename: Marcio
authors.initials: M
authors.lastname: Nucci
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Park
authors.forename: Simone A
authors.initials: SA
authors.lastname: Nouér
authors.forename: Beth
authors.initials: B
authors.lastname: Arthington-Skaggs
authors.forename: Daniel A
authors.initials: DA
authors.lastname: da Matta
authors.forename: David
authors.initials: D
authors.lastname: Warnock
authors.forename: Juliette
authors.initials: J
authors.lastname: Morgan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology; D001769:Blood / Q000382:microbiology; D001938:Brazil; D002175:Candida / Q000145:classification* / Q000187:drug effects / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D025141:Drug Resistance, Fungal; D026141:Drug Resistance, Multiple, Fungal; D005260:Female; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D006761:Hospitals; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013223:Statistics as Topic
chemical_list: D000935:Antifungal Agents