title: Candida glabrata: an emerging pathogen in Brazilian tertiary care hospitals.
abstract: Candida glabrata is an infrequent cause of candidemia in Brazilian public hospitals. We investigated putative differences in the epidemiology of candidemia in institutions with different sources of funding. Prospective laboratory-based surveillance of candidemia was conducted in seven private and two public Brazilian tertiary care hospitals. Among 4,363 episodes of bloodstream infection, 300 were caused by Candida spp. (6.9%). Incidence rates were significantly higher in public hospitals, i.e., 2.42 vs. 0.91 episodes per 1,000 admissions (P< 0.01). Patients in private hospitals were older, more likely to be in an intensive care unit and to have been exposed to fluconazole before candidemia. Candida parapsilosis was more frequently recovered as the etiologic agent in public (33% vs. 16%, P< 0.001) hospitals, whereas C. glabrata was more frequently isolated in private hospitals (13% vs. 3%, P < 0.001). Fluconazole resistance among C. glabrata isolates was more frequent in private hospitals (76.5% vs. 20%, P = 0.02). The 30-day mortality was slightly higher among patients in public hospitals (53% vs. 43%, P = 0.10). Candida glabrata is an emerging pathogen in private institutions and in this setting, fluconazole should not be considered as a safe option for primary therapy of candidemia.
authors: Division of Infectious Diseases – Hospital São Paulo, Escola Paulista de Medicina-Universidade Federal de São Paulo, Rua Botucatu, 740 S ã o Paulo, Brasil. colomboal@terra.com.br
authors: Arnaldo L
authors: AL
authors: Colombo
authors: Marcia
authors: M
authors: Garnica
authors: Luis Fernando
authors: LF
authors: Aranha Camargo
authors: Clovis Arns
authors: CA
authors: Da Cunha
authors: Antonio Carlos
authors: AC
authors: Bandeira
authors: Danielle
authors: D
authors: Borghi
authors: Tatiana
authors: T
authors: Campos
authors: Ana Lucia
authors: AL
authors: Senna
authors: Maria Eugenia
authors: ME
authors: Valias Didier
authors: Viviane Carvalho
authors: VC
authors: Dias
authors: Marcio
authors: M
authors: Nucci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D041221:Candida glabrata / Q000187:drug effects / Q000302:isolation & purification*; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003710:Demography; D025141:Drug Resistance, Fungal; D062665:Epidemiological Monitoring; D005260:Female; D015725:Fluconazole / Q000494:pharmacology / Q000627:therapeutic use; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007755:Laboratories, Hospital; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D063128:Tertiary Health Care; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole