title: Outbreak of candidemia caused by fluconazole resistant Candida parapsilosis strains in an intensive care unit.
abstract: Candidemia is an increasing problem in tertiary care hospitals worldwide. Here, we report the first outbreak of candidemia caused by fluconazole-resistant C. parapsilosis (FRCP) strains in Brazil.
  
  
  
  This was a cross-sectional study of clinical and microbiological data of all candidemic episodes diagnosed from July 2011 to February 2012 in a 200-bed tertiary care hospital. Initial yeast identification and susceptibility testing were performed using the VITEK 2 - System. Isolates of Candida spp. resistant to fluconazole were sent to a reference laboratory (LEMI-UNIFESP) for further molecular identification and confirmation of resistance by CLSI microdilution test. A multivariate analysis was conducted to identify factors associated with FRCP infection.
  
  
  
  We identified a total of 40 critically ill patients with candidemia (15 women) with a median age of 70 years. The incidence of candidemia was 6 cases/1,000 patients admissions, including 28 cases (70 %) of infection with C. parapsilosis, 21 of which (75 %) were resistant to fluconazole. In only 19 % of FRCP candidemia cases had fluconazole been used previously. The results of our study indicated that diabetes is a risk factor for FRCP candidemia (p = 0.002). Overall, mortality from candidemia was 45 %, and mortality from episodes of FRCP infections was 42.9 %.
  
  
  
  The clustering of incident cases in the ICU and molecular typing of strains suggest horizontal transmission of FRCP. Accurate vigilant monitoring for new nosocomial strains of FRCP is required.
authors.affiliation: Ed. América Office Tower, SCN Q 1 BL F, - sala-1016, Asa Norte, Brasília, DF, 70711-905, Brazil. hpmarconi@gmail.com.
authors.forename: Henrique Marconi Sampaio
authors.initials: HM
authors.lastname: Pinhati
authors.affiliation: Ed. América Office Tower, SCN Q 1 BL F, - sala-1016, Asa Norte, Brasília, DF, 70711-905, Brazil.
authors.forename: Luiz Augusto
authors.initials: LA
authors.lastname: Casulari
authors.affiliation: Universidade Federal de São Paulo, Rua Pedro de Toledo, 669, quinto andar, São Paulo, SP, 04039-032, Brazil.
authors.forename: Ana Carolina Remondi
authors.initials: AC
authors.lastname: Souza
authors.affiliation: Universidade Federal de São Paulo, Rua Pedro de Toledo, 669, quinto andar, São Paulo, SP, 04039-032, Brazil.
authors.forename: Ricardo Andreotti
authors.initials: RA
authors.lastname: Siqueira
authors.affiliation: Ed. América Office Tower, SCN Q 1 BL F, - sala-1016, Asa Norte, Brasília, DF, 70711-905, Brazil.
authors.forename: Camila Maria Gomes
authors.initials: CM
authors.lastname: Damasceno
authors.affiliation: Universidade Federal de São Paulo, Rua Pedro de Toledo, 669, quinto andar, São Paulo, SP, 04039-032, Brazil.
authors.forename: Arnaldo Lopes
authors.initials: AL
authors.lastname: Colombo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents; D001938:Brazil / Q000453:epidemiology; D002175:Candida; D058387:Candidemia / Q000453:epidemiology / Q000382:microbiology*; D003428:Cross Infection / Q000382:microbiology; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D025141:Drug Resistance, Fungal; D005260:Female; D015725:Fluconazole; D006761:Hospitals; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole
keywords: Antifungal treatment; Candida sp; Candidemia; Fluconazole resistance