Outbreak of candidemia caused by fluconazole resistant Candida parapsilosis strains in an intensive care unit.

BACKGROUND: 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. METHODS: 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. RESULTS: 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 %. CONCLUSIONS: 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.

Bactérias multirresistentes: enfoque sobre os Gram-negativos hospitalares / Multiresistant bacteria: an approach to cope with nosocomial Gram negative species

No início deste novo milênio, crescente aumento da resistência bacteriana aos antibióticos disponíveis vem-se caracterizando como evento preocupante. Por outro aspecto, tem havido desinteresse da indústria na produção de novos antimicrobianos. Desse modo, o tratamento das infecções está se tornando um desafio crescente. Esta revisãodiscorre sobre o tema, procurando caracterizar a magnitude do problema e como lidar com este na prática assistencial diária nos hospitais. A presente abordagem enfoca os germes Gram-negativos hospitalares, tendo por ponto de partida os principais mecanismos de resistência neles identificados.

At the beginning of this new millennium, an increasing bacterial resistance to the available antibiotics has been characterized as an overwhelming event. On the other hand, there was a lack of interest from industry in producing new antimicrobials. Thus the treatment of infections is becoming an increasing challenge. This review on the subject tries to characterizethe magnitude of the problem and how to cope with daily practice in hospitals. The approach focuses on the nosocomial Gram-negative species having as a starting point its main identified mechanisms of resistance.