title: Ten-year study of species distribution and antifungal susceptibilities of Candida bloodstream isolates at a Brazilian tertiary hospital.
abstract: To describe the incidence and susceptibility profile of Candida bloodstream infections in a tertiary-care hospital, we performed a retrospective observational study from 1998 to 2007. Comorbidities and risk factors were compiled from all cases. In vitro susceptibility testing to fluconazole, itraconazole, voriconazole, and amphotericin B was performed for 100 isolates, and caspofungin was tested for C. parapsilosis complex. In a ten-year evaluation of candidemias, 44 % were caused by C. albicans, and species of the C. parapsilosis complex were the second most frequent agents (37 %). Other species presented lower incidences (C. tropicalis, 13 %, C. glabrata, 5 %, and C. krusei, 1 %). Neither C. dubliniensis nor C. metapsilosis were observed in this study. C. orthopsilosis (3 %) and C. parapsilosis stricto sensu (34 %) were also found. Species distribution was independent of catheterization, mechanical ventilation, or previous use of antifungals or corticoids. Parenteral nutrition administration was strongly related to C. glabrata infection, and the highest mortality (80 %) was observed in patients infected by this species. All C. albicans isolates showed high susceptibility to all tested drugs. However, two C. parapsilosis stricto sensu isolates presented high minimum inhibitory concentration (MIC) (4 mg/L each) to fluconazole, and one exhibited voriconazole MIC of 0.25 mg/L, highlighting the cross-resistance to these azoles. All isolates of C. tropicalis and C. glabrata showed no resistance to any drug tested. No difference was noted between C. parapsilosis and C. orthopsilosis susceptibilities to caspofungin. Our results suggest that resistance to amphotericin B, fluconazole, voriconazole, itraconazole, and caspofungin in Brazilian Candida bloodstream isolates is still uncommon.
authors: Mycology Unit, Adolfo Lutz Institute Adolfo Lutz, Av Dr Arnaldo 355, São Paulo 01246-902, Brazil.
authors: L X
authors: LX
authors: Bonfietti
authors: M W
authors: MW
authors: Szeszs
authors: M R
authors: MR
authors: Chang
authors: M A
authors: MA
authors: Martins
authors: S R B S
authors: SR
authors: Pukinskas
authors: M O
authors: MO
authors: Nunes
authors: G H
authors: GH
authors: Pereira
authors: A M M
authors: AM
authors: Paniago
authors: S U
authors: SU
authors: Purisco
authors: M S C
authors: MS
authors: Melhem
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000494:pharmacology*; D001769:Blood / Q000382:microbiology*; D001938:Brazil / Q000453:epidemiology; D002175:Candida / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D002177:Candidiasis / Q000097:blood / Q000453:epidemiology / Q000382:microbiology*; D025141:Drug Resistance, Fungal; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000935:Antifungal Agents