Surveillance of Candida spp bloodstream infections: epidemiological trends and risk factors of death in two Mexican tertiary care hospitals.
BACKGROUND
Larger populations at risk, broader use of antibiotics and longer hospital stays have impacted on the incidence of Candida sp. bloodstream infections (CBSI).


OBJECTIVE
To determine clinical and epidemiologic characteristics of patients with CBSI in two tertiary care reference medical institutions in Mexico City.


METHODS
Prospective and observational laboratory-based surveillance study conducted from 07/2008 to 06/2010.


METHODS
All patients with CBSI were included. Identification and antifungal susceptibility were performed using CLSI M27-A3 standard procedures. Frequencies, Mann-Whitney U test or T test were used as needed. Risk factors were determined with multivariable analysis and binary logistic regression analysis.


RESULTS
CBSI represented 3.8% of nosocomial bloodstream infections. Cumulative incidence was 2.8 per 1000 discharges (incidence rate: 0.38 per 1000 patient-days). C. albicans was the predominant species (46%), followed by C. tropicalis (26%). C. glabrata was isolated from patients with diabetes (50%), and elderly patients. Sixty-four patients (86%) received antifungals. Amphotericin-B deoxycholate (AmBD) was the most commonly used agent (66%). Overall mortality rate reached 46%, and risk factors for death were APACHE II score ≥ 16 (OR = 6.94, CI95% = 2.34-20.58, p<0.0001), and liver disease (OR = 186.11, CI95% = 7.61-4550.20, p = 0.001). Full susceptibility to fluconazole, AmBD and echinocandins among C. albicans, C. tropicalis, and C. parapsilosis was observed.


CONCLUSIONS
The cumulative incidence rate in these centers was higher than other reports from tertiary care hospitals from Latin America. Knowledge of local epidemiologic patterns permits the design of more specific strategies for prevention and preemptive therapy of CBSI.
Department of Medicine, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Mexico City, Mexico.
Dora E
DE
Corzo-Leon
Hospital Escuela, Tegucigalpa, Honduras.
Tito
T
Alvarado-Matute
Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Arnaldo L
AL
Colombo
Division of Infectious Diseases, National Cancer Institute, Mexico City, Mexico.
Patricia
P
Cornejo-Juarez
Department of Internal Medicine, Universidad Nacional de Colombia, Bogota, Colombia.
Jorge
J
Cortes
Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
Juan I
JI
Echevarria
Infectious Diseases, Hospital Vargas de Caracas and Centro Medico de Caracas, Caracas, Venezuela.
Manuel
M
Guzman-Blanco
Department of Medicine, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Mexico City, Mexico.
Alejandro E
AE
Macias
University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Marcio
M
Nucci
Department of Medicine, Memorial Hermann Texas Medical Center, University of Texas Medical School at Houston, Houston, Texas, United States of America.
Luis
L
Ostrosky-Zeichner
Department of Medicine, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Mexico City, Mexico.
Alfredo
A
Ponce-de-Leon
Hospital de Clinicas, Universidade Federal do Parana, Curitiba, Brazil.
Flavio
F
Queiroz-Telles
Department of Pediatrics, Hospital Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile, Santiago, Chile.
Maria E
ME
Santolaya
Department of Medicine, Clinica Alemana, Universidad del Desarrollo, Santiago, Chile.
Luis
L
Thompson-Moya
Infectious Diseases Unit, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina.
Iris N
IN
Tiraboschi
Hospital Vozandes, Facultad de Medicina, Pontificia Universidad Catolica del Ecuador, Quito, Ecuador.
Jeannete
J
Zurita
Department of Medicine, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Mexico City, Mexico.
Jose
J
Sifuentes-Osornio
D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000737:chemistry; D002175:Candida; D002176:Candida albicans; D041221:Candida glabrata; D041022:Candida tropicalis; D002177:Candidiasis / Q000453:epidemiology / Q000401:mortality*; D003840:Deoxycholic Acid / Q000737:chemistry; D004338:Drug Combinations; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D008800:Mexico; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D062606:Tertiary Care Centers; D016896:Treatment Outcome
D004338:Drug Combinations; D003840:Deoxycholic Acid; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination; D015725:Fluconazole