title: Five-year evaluation of bloodstream yeast infections in a tertiary hospital: the predominance of non-C. albicans Candida species.
abstract: This is a retrospective observational study of clinical and epidemiologic data from bloodstream yeast infections over 5 years (2004-2008) in a tertiary-care hospital. During this period, there were 52 such infections, at a rate of 2.4 per 1,000 hospital admissions. Non-C. albicans Candida species and other genera were responsible for 82% of infections, with C. tropicalis and C. parapsilosis being the most common. In 2008 no C. albicans infections occurred. Several uncommon fungal pathogens were observed, including Trichosporon asahii, Rhodotorula spp. and Candida zeylanoides. Of 16 isolates tested, 3 (19%) were resistant to fluconazole, including one C. zeylanoides (MIC 8 microg/ml) and one C. tropicalis (MIC 16 microg/ml) isolate, as well as intrinsically resistant C. krusei. All isolates tested were susceptible to itraconazole (n = 7) and amphotericin B (n = 8). Yeast infections were associated with severe underlying diseases, mainly hematological/solid cancers (71%), hospitalization in the ICU (41%), central venous catheters (80%), and use of antimicrobials (94%). The overall mortality rate was 50%. Our finding of a predominance of non-C. albicans Candida species infection with uncommon yeasts, and fluconazole resistance, suggests the need for continuous surveillance of fungemia and of antibiotic susceptibility trends, in order to adopt treatment strategies applicable to particular healthcare institutions.
authors.affiliation: Departments of Infectious Diseases and Infection Control, Hospital Brigadeiro, University of São Paulo, Av. Jandira 79/231, São Paulo, Brazil. ghpereira1@terra.com.br
authors.forename: Graziella H
authors.initials: GH
authors.lastname: Pereira
authors.forename: Patrícia Rady
authors.initials: PR
authors.lastname: Müller
authors.forename: Maria Walderez
authors.initials: MW
authors.lastname: Szeszs
authors.forename: Anna S
authors.initials: AS
authors.lastname: Levin
authors.forename: Márcia S C
authors.initials: MS
authors.lastname: Melhem
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000494:pharmacology; D000935:Antifungal Agents / Q000494:pharmacology; D002175:Candida / Q000145:classification* / Q000302:isolation & purification*; D002177:Candidiasis / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D006761:Hospitals; D006801:Humans; D007223:Infant; D017964:Itraconazole / Q000494:pharmacology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D012248:Rhodotorula / Q000145:classification / Q000302:isolation & purification; D014250:Trichosporon / Q000145:classification / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B