title: Epidemiology and Microbiologic Characterization of Nosocomial Candidemia from a Brazilian National Surveillance Program.
abstract: Candidemia is a growing problem in hospitals all over the world. Despite advances in the medical support of critically ill patients, candidiasis leads to prolonged hospitalization, and has a crude mortality rate around 50%. We conducted a multicenter surveillance study in 16 hospitals distributed across five regions of Brazil to assess the incidence, species distribution, antifungal susceptibility, and risk factors for bloodstream infections due to Candida species. From June 2007 to March 2010, we studied a total of 2,563 nosocomial bloodstream infection (nBSI) episodes. Candida spp. was the 7th most prevalent agent. Most of the patients were male, with a median age of 56 years. A total of 64 patients (46.7%) were in the ICU when candidemia occurred. Malignancies were the most common underlying condition (32%). The crude mortality rate of candidemia during the hospital admission was 72.2%. Non-albicans species of Candida accounted for 65.7% of the 137 yeast isolates. C. albicans (34.3%), Candida parapsilosis (24.1%), Candida tropicalis (15.3%) and Candida glabrata (10.2%) were the most prevalent species. Only 47 out of 137 Candida isolates were sent to the reference laboratory for antifungal susceptibility testing. All C. albicans, C. tropicalis and C. parapsilosis isolates were susceptible to the 5 antifungal drugs tested. Among 11 C. glabrata isolates, 36% were resistant to fluconazole, and 64% SDD. All of them were susceptible to anidulafungin and amphotericin B. We observed that C. glabrata is emerging as a major player among non-albicans Candida spp. and fluconazole resistance was primarily confined to C. glabrata and C. krusei strains. Candida resistance to echinocandins and amphotericin B remains rare in Brazil. Mortality rates remain increasingly higher than that observed in the Northern Hemisphere countries, emphasizing the need for improving local practices of clinical management of candidemia, including early diagnosis, source control and precise antifungal therapy.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: André Mario
authors.initials: AM
authors.lastname: Doi
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Antonio Carlos Campos
authors.initials: AC
authors.lastname: Pignatari
authors.affiliation: Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
authors.affiliation: Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Alexandre Rodrigues
authors.initials: AR
authors.lastname: Marra
authors.affiliation: Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Luis Fernando Aranha
authors.initials: LF
authors.lastname: Camargo
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Ricardo Andreotti
authors.initials: RA
authors.lastname: Siqueira
authors.affiliation: Laboratório Central, Hospital São Paulo, São Paulo, SP, Brazil.
authors.forename: Vivian Pereira
authors.initials: VP
authors.lastname: da Mota
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Arnaldo Lopes
authors.initials: AL
authors.lastname: Colombo
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002175:Candida / Q000302:isolation & purification*; D058387:Candidemia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D025141:Drug Resistance, Fungal; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate