Candidemia in a brazilian tertiary hospital: microbiological and clinical features over a six-year period

Yeasts are becoming a common cause of nosocomial fungal infections in immunocompromised patients. Such infections often develop into sepsis with high mortality rates. The aim of this study was to evaluate some of the numerous factors associated with the development of candidemia. Medical records were retrospectively analyzed of 98 Candida spp. patients. Results showed that the most prevalent risk factors for developing candidemia were: antibiotics and antifungal agents (93.9% and 79.6%, respectively); the use of central venous catheter (93.9%); mechanical ventilation (73.5%); and parenteral nutrition (60.2%). The main species of Candida found were: C. parapsilosis (37.76%), C. albicans (33.67%); and others (28.57%). C. glabrata showed the highest mortality rate (75%), followed by C. tropicalis (57.1%) and C. albicans (54.5%). The elevated mortality rate found in this study indicates that preventive measures against candidemia must be emphasized in hospitals.(AU)

INCIDÊNCIA E FATORES PREDITORES PARA CANDIDEMIA EM PACIENTES INTERNADOS EM UNIDADES DE TERAPIA INTENSIVA DE HOSPITAL TERCIÁRIO NA REGIÃO CENTRO-OESTE DO BRASIL

Candidemia, uma frequente infecção hospitalar de corrente sanguínea, aumenta o tempo de internação, eleva os custos hospitalares e aumenta o número de óbitos. Realizou-se uma coorte com pacientes internados em unidades de terapia intensiva adulto e neonatal entre 2014-2016 para avaliar o risco para desenvolver candidemia e seus fatores predisponentes. Após o seguimento de 44405 pacientes-dia observou-se o desenvolvimento de 36 casos de candidemia, sendo 17 em UTI neonatal e 19 em UTI adulto. O principal agente etiológico de candidemia em pacientes internados na UTI neonatal foi o complexo C. parapsilosis e em UTI adulto foi C. albicans. A incidência de candidemia foi estatisticamente semelhante entre as UTIs, mas a proporção de óbitos por candidemia foi estatisticamente maior entre pacientes internados na UTI neonatal. Após ajuste por outras variáveis, tempo de internação por mais de 20 dias (RR=11,18; IC95%=3,34-37,40), antibioticoterapia com glicopeptídeos concomitante com nutrição parenteral (RR=30,85; IC95%=4,70-202,65) e uso de fluconazol por mais de 10 dias (RR=0,21; IC95%=0,10-0,48) se comportaram como fatores preditores para desenvolver candidemia. O risco de candidemia foi semelhante entre UTI adulto e neonatal, diferente entre as espécies do gênero Candida e maior entre os pacientes que desenvolveram candidúria. Poucos estudos epidemiológicos sobre candidemia avaliaram esse desfecho por meio de coortes, destes, alguns realizaram análise de sobrevida (tempo entre o diagnóstico e o óbito), porém a avaliação do risco para desenvolver candidemia, ou seja, os fatores predisponentes envolvidos no tempo entre a internação e o seu diagnóstico, pode auxiliar na melhor compreensão desta importante infecção.

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Candidemia in a brazilian tertiary hospital: microbiological and clinical features over a six-year period

Yeasts are becoming a common cause of nosocomial fungal infections in immunocompromised patients. Such infections often develop into sepsis with high mortality rates. The aim of this study was to evaluate some of the numerous factors associated with the development of candidemia. Medical records were retrospectively analyzed of 98 Candida spp. patients. Results showed that the most prevalent risk factors for developing candidemia were: antibiotics and antifungal agents (93.9% and 79.6%, respectively); the use of central venous catheter (93.9%); mechanical ventilation (73.5%); and parenteral nutrition (60.2%). The main species of Candida found were: C. parapsilosis (37.76%), C. albicans (33.67%); and others (28.57%). C. glabrata showed the highest mortality rate (75%), followed by C. tropicalis (57.1%) and C. albicans (54.5%). The elevated mortality rate found in this study indicates that preventive measures against candidemia must be emphasized in hospitals.(AU)

Pericardite bacteriana com subsequente desenvolvimento de endocardite mural por levedura do complexo Candida parapsilosis / Bacterial pericarditis with subsequent development of mural endocarditis caused by Candida parapsilosis complex yeast

A infecção primária do pericárdio e do endocárdio é rara. Este estudo descreve a evolução de uma criança com cardite reumática aguda, complicada com pericardite infecciosa bacteriana, secundária a abscessos de pele e endocardite fúngica. O tempo prolongado de internação, o uso de cateter venoso central e a antibioticoterapia de amplo espectro foram os fatores que provavelmente favoreceram a colonização, a candidíase invasiva e o desenvolvimento da endocardite por levedura do complexo Candida parapsilosis.(AU)

The primary infection of pericardium and endocardium rarely occurs. This study reports the evolution of a child with acute rheumatic carditis with subsequent pericardial bacterial infection, due to cutaneous abscess and fungal endocarditis. Probably, the long hospital stay, the usage of central venous catheter and the broad-spectrum antibiotics enhanced the colonization, the invasive candidiasis induction and the development of fungal endocarditis by Candida parapsilosis complex yeast.(AU)

Candida spp: manual identification (reference method) and automated identification (Vitek system platform)

Yeasts are becoming a common cause of nosocomial fungal infections that affect immunocompromised patients. Such infections can evolve into sepsis, whose mortality rate is high. This study aimed to evaluate the viability of Candida species identification by the automated system Vitek-Biomerieux (Durham, USA). Ninety-eight medical charts referencing the Candida spp. samples available for the study were retrospectively analyzed. The system Vitek-Biomerieux with Candida identification card is recommended for laboratory routine use and presents 80.6% agreement with the reference method. By separate analysis of species, 13.5% of C. parapsilosis samples differed from the reference method, while the Vitek system wrongly identified them as C. tropicalis, C. lusitaneae or as Candida albicans. C. glabrata presented a discrepancy of only one sample (25%), and was identified by Vitek as C. parapsilosis. C. guilliermondii also differed in only one sample (33.3%), being identified as Candida spp. All C. albicans, C. tropicalis and C. lusitaneae samples were identified correctly.(AU)

Candida spp: manual identification (reference method) and automated identification (Vitek system platform)

Yeasts are becoming a common cause of nosocomial fungal infections that affect immunocompromised patients. Such infections can evolve into sepsis, whose mortality rate is high. This study aimed to evaluate the viability of Candida species identification by the automated system Vitek-Biomerieux (Durham, USA). Ninety-eight medical charts referencing the Candida spp. samples available for the study were retrospectively analyzed. The system Vitek-Biomerieux with Candida identification card is recommended for laboratory routine use and presents 80.6% agreement with the reference method. By separate analysis of species, 13.5% of C. parapsilosis samples differed from the reference method, while the Vitek system wrongly identified them as C. tropicalis, C. lusitaneae or as Candida albicans. C. glabrata presented a discrepancy of only one sample (25%), and was identified by Vitek as C. parapsilosis. C. guilliermondii also differed in only one sample (33.3%), being identified as Candida spp. All C. albicans, C. tropicalis and C. lusitaneae samples were identified correctly.

Candidiasis in pediatric patients with cancer interned in a university hospital

Fungi are common causes of infection in immunocompromised patients. Candida species are frequently involved in these cases. In order to investigate candidiasis in pediatric patients with cancer, clinical samples were collected from one hundred and twenty two patients interned in the Oswaldo Cruz University Hospital in Recife, Brazil. Yeasts were isolated from thirty-four clinical samples. The species isolated were: Candida albicans (fourteen isolates), C. parapsilosis (nine isolates), C. guilliermondii (two isolates) and C. tropicalis (two isolates). We found that candidemia was most frequent in patients with malignant hematology and that C. parapsilosis infections caused the highest mortality.

Os fungos são causas comuns de infecções em pacientes imunocomprometidos e espécies de Candida são freqüentemente envolvidas nesses casos. A fim de investigar infecção fúngica em pacientes pediátricos com câncer, amostras clínicas foram coletadas de cento e vinte dois pacientes internados no Hospital Universitário Oswaldo Cruz em Recife, Brasil. Leveduras foram isoladas de trinta e quatro amostras clínicas. As leveduras isoladas foram: Candida albicans (catorze isolados), C. parapsilosis (nove isolados), C. guilliermondii (dois isolados) e C. tropicalis (dois isolados). Descobrimos que candidemia foi mais freqüente em doentes com hematologias malignas e que C. parapsilosis apresentou maior mortalidade.

Candida isolates in tertiary hospitals in northeastern Brazil

Candida is an opportunistic pathogen that affects highrisk patients who are either immunocompromised or critically ill and is associated with almost 80% of all nosocomial fungal infections, representing the major cause of fungemia with high mortality rates (40%). Candida albicans is the main cause of candidemia and among the non-albicans species C. parapsilosis, C. glabrata and C. tropicalis are the most frequent agents. The aim of this study was to evaluate the distribution of Candida species in two tertiary hospitals in Recife, Northeastern Brazil. It began by surveying all positive Candida cultures processed by the microbiology laboratory from September 2003 to September 2006. The cultures, originated from various types of biological material (blood, urine, tracheal, catheter and others), were processed by Vitec® system (Biomerieux SA, France). A total of 1.279 (hospital A: 837; hospital B: 442) sample isolates were positive for Candida. The most frequent species in both hospitals were: C. albicans (367), C. tropicalis (363), C. parapsilosis (147), C. glabrata (81), C. krusei (30) and C. guillermondii (14). The isolates were obtained from 746 hospitalized patients. A total of 221 positive hemocultures were detected in 166 different patients in both hospitals, and 113 (68.1%) of these patients with positive hemocultures presented Candida in other body sites.This study shows thatCandida non-albicans was the main isolated agent and evidences the importante of C. tropicalis in nosocomial fungal infections.

Candida é um patógeno oportunista que afeta pacientes de alto risco que estão também imunocomprometidos ou criticamente doentes, estando associada a quase 80% de todos os casos de infecções fúngicas nosocomiais, representando a maior causa de fungemia com alta taxa de mortalidade (40%). Candida albicans é a principal causa de candidemia e dentre as espécies não-albicans a C. parapsilosis, C. glabrata e C. tropicalis são os agentes mais frequentes. O objetivo deste estudo foi avaliar a distribuição das espécies de Candida em dois hospitais terciários no Recife, nordeste do Brasil. Foi realizado um levantamento de todas as culturas positivas para Candida processadas pelo laboratório de microbiologia de Setembro de 2003 a Setembro de 2006. Todas as culturas originadas de vários tipos de material biológico (sangue, urina, traquéia, catéter e outros) foram processadas pelo sistema Vitec® (Biomerrieux SA, France). Um total de 1.279 amostras (hospital A:837; hospital B: 442) foram positivas para Candida. As espécies mais frequentes em ambos os hospitais foram: C.albicans (367), C. tropicalis (363), C. parapsilosis (147), C. glabrata (81), C. krusei (30) e C. guillermondii (14). Os isolados foram obtidos de 746 pacientes hospitalizados. Um total de 221 hemoculturas positivas foram detectadas em 166 diferentes pacientes em ambos os hospitais, e 113 (68,1%) destes pacientes com hemoculturas positivas apresentavam Candida em outros locais do corpo. Este estudo mostrou que Candida não-albicans foi o principal agente isolado e prova a importância da C. tropicalis em infecções fúngicas nosocomiais.

Candida isolates in tertiary hospitals in northeastern Brazil

Candida is an opportunistic pathogen that affects highrisk patients who are either immunocompromised or critically ill and is associated with almost 80% of all nosocomial fungal infections, representing the major cause of fungemia with high mortality rates (40%). Candida albicans is the main cause of candidemia and among the non-albicans species C. parapsilosis, C. glabrata and C. tropicalis are the most frequent agents. The aim of this study was to evaluate the distribution of Candida species in two tertiary hospitals in Recife, Northeastern Brazil. It began by surveying all positive Candida cultures processed by the microbiology laboratory from September 2003 to September 2006. The cultures, originated from various types of biological material (blood, urine, tracheal, catheter and others), were processed by Vitec® system (Biomerieux SA, France). A total of 1.279 (hospital A: 837; hospital B: 442) sample isolates were positive for Candida. The most frequent species in both hospitals were: C. albicans (367), C. tropicalis (363), C. parapsilosis (147), C. glabrata (81), C. krusei (30) and C. guillermondii (14). The isolates were obtained from 746 hospitalized patients. A total of 221 positive hemocultures were detected in 166 different patients in both hospitals, and 113 (68.1%) of these patients with positive hemocultures presented Candida in other body sites.This study shows thatCandida non-albicans was the main isolated agent and evidences the importante of C. tropicalis in nosocomial fungal infections.

Candida é um patógeno oportunista que afeta pacientes de alto risco que estão também imunocomprometidos ou criticamente doentes, estando associada a quase 80% de todos os casos de infecções fúngicas nosocomiais, representando a maior causa de fungemia com alta taxa de mortalidade (40%). Candida albicans é a principal causa de candidemia e dentre as espécies não-albicans a C. parapsilosis, C. glabrata e C. tropicalis são os agentes mais frequentes. O objetivo deste estudo foi avaliar a distribuição das espécies de Candida em dois hospitais terciários no Recife, nordeste do Brasil. Foi realizado um levantamento de todas as culturas positivas para Candida processadas pelo laboratório de microbiologia de Setembro de 2003 a Setembro de 2006. Todas as culturas originadas de vários tipos de material biológico (sangue, urina, traquéia, catéter e outros) foram processadas pelo sistema Vitec® (Biomerrieux SA, France). Um total de 1.279 amostras (hospital A:837; hospital B: 442) foram positivas para Candida. As espécies mais frequentes em ambos os hospitais foram: C.albicans (367), C. tropicalis (363), C. parapsilosis (147), C. glabrata (81), C. krusei (30) e C. guillermondii (14). Os isolados foram obtidos de 746 pacientes hospitalizados. Um total de 221 hemoculturas positivas foram detectadas em 166 diferentes pacientes em ambos os hospitais, e 113 (68,1%) destes pacientes com hemoculturas positivas apresentavam Candida em outros locais do corpo. Este estudo mostrou que Candida não-albicans foi o principal agente isolado e prova a importância da C. tropicalis em infecções fúngicas nosocomiais.