title: Prospective observational study of candidemia in São Paulo, Brazil: incidence rate, epidemiology, and predictors of mortality.
abstract: BACKGROUND
  Studies conducted in tertiary care hospitals of different European countries and the United States have shown incidence rates of candidemia ranging from 0.17 to 0.76 and 0.28 to 0.96 per 1,000 admissions, respectively. So far, only 1 study has evaluated the incidence rates of candidemia in tertiary care hospitals in Latin American countries.
  
  
  OBJECTIVE
  To evaluate the epidemiology of candidemia in 4 tertiary care hospitals in São Paulo, Brazil.
  
  
  METHODS
  Multicenter, laboratory-based surveillance of candidemia.
  
  
  RESULTS
  A total of 7,038 episodes of bloodstream infection were identified, and Candida species accounted for 282 cases (4%). The incidence rate of candidemia was 1.66 candidemic episodes per 1,000 hospital admissions. Candida albicans was the most frequently isolated Candida species in all hospitals, but Candida species other than C. albicans accounted for 62% of isolates, including predominantly Candida parapsilosis and Candida tropicalis. Azole resistance was restricted to only 2% of all Candida isolates (1 isolate of Candida glabrata and 4 isolates of Candida rugosa). Candidemia was mostly documented in surgical patients with long durations of hospital stay. The crude mortality rate was 61%, and advanced age and high Acute Physiology and Chronic Health Evaluation II score were both conditions independently associated with risk of death.
  
  
  CONCLUSIONS
  We observed in our series a higher incidence rate of candidemia than that reported in European countries and the United States. Advanced age and a high Acute Physiology and Chronic Health Evaluation II score were factors associated with a higher probability of death in candidemic patients. Fluconazole-resistant Candida strains are still a rare finding in our case-based study of candidemia.
authors.affiliation: Division of Infectious Diseases, Federal University of São Paulo, São Paulo, Brazil. colomboal@terra.com.br
authors.forename: Arnaldo L
authors.initials: AL
authors.lastname: Colombo
authors.forename: Thaís
authors.initials: T
authors.lastname: Guimarães
authors.forename: Ligia R B F
authors.initials: LR
authors.lastname: Silva
authors.forename: Leila Paula
authors.initials: LP
authors.lastname: de Almeida Monfardini
authors.forename: Anna Karenine B
authors.initials: AK
authors.lastname: Cunha
authors.forename: Patrícia
authors.initials: P
authors.lastname: Rady
authors.forename: Thelma
authors.initials: T
authors.lastname: Alves
authors.forename: Robert C
authors.initials: RC
authors.lastname: Rosas
mesh_terms: D018806:APACHE; 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 / Q000302:isolation & purification; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004198:Disease Susceptibility; D005260:Female; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents