title: High rate of Candida deep-seated infection in patients under chronic hemodialysis with extended central venous catheter use.
abstract: BACKGROUND
  Hemodialysis has been described as an important risk factor for the development of candidemia in patients suffering from chronic renal failure.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the epidemiology of candidemia in outpatients with renal replacement therapy (RRT) by hemodialysis where the fungemia clearly represents a healthcare-associated infection.
  
  
  METHODS
  We retrospectively collected clinical and laboratory data from patients undergoing at least 3 months of RRT by hemodialysis who developed candidemia within 48h of hospital admission.
  
  
  RESULTS
  We identified 14 patients with candidemia with central venous catheters (CVC) in place for 11-277 days before developing fungemia. Deep-seated infection was documented in 6 out of 14 candidiasis cases (43%), including 5 cases of endocarditis (36%).
  
  
  CONCLUSIONS
  CVC in patients under RRT should be promptly replaced by fistulas and grafts to avoid bloodstream infections. Facing a case of candidemia, adequate source control and prompt initiation of antifungal therapy are mandatory to avoid morbidity and mortality.
authors.affiliation: Laboratório Especial de Micologia, Disciplina de Infectologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Ana Paula Jafet
authors.initials: AP
authors.lastname: Ourives
authors.affiliation: Laboratório Especial de Micologia, Disciplina de Infectologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Sarah Santos
authors.initials: SS
authors.lastname: Gonçalves
authors.affiliation: Laboratório Especial de Micologia, Disciplina de Infectologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Ricardo Andreotti
authors.initials: RA
authors.lastname: Siqueira
authors.affiliation: Laboratório Especial de Micologia, Disciplina de Infectologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Ana Carolina Remondi
authors.initials: AC
authors.lastname: Souza
authors.affiliation: Disciplina de Nefrologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Maria Eugenia F
authors.initials: ME
authors.lastname: Canziani
authors.affiliation: Hospital do Rim e Hipertensão-Fundação Oswaldo Ramos, Brazil.
authors.forename: Silvia Regina
authors.initials: SR
authors.lastname: Manfredi
authors.affiliation: Hospital Israelita Albert Einstein, Brazil and Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brazil.
authors.forename: Luci
authors.initials: L
authors.lastname: Correa
authors.affiliation: Laboratório Especial de Micologia, Disciplina de Infectologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil. Electronic address: arnaldolcolombo@gmail.com.
authors.forename: Arnaldo Lopes
authors.initials: AL
authors.lastname: Colombo
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D058387:Candidemia / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D058365:Candidiasis, Invasive / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D004198:Disease Susceptibility; D004696:Endocarditis / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D009877:Endophthalmitis / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: Candida parapsilosis; Candidemia; Candidemia comunitaria adquirida; Community acquired candidemia; Hemodialysis; Hemodiálisis