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Xiao G, Liao W, Zhang Y, Luo X, Zhang C, Li G, Yang Y, Xu Y. Analysis of fungal bloodstream infection in intensive care units in the Meizhou region of China: species distribution and resistance and the risk factors for patient mortality. BMC Infect Dis 2020; 20:599. [PMID: 32795259 PMCID: PMC7427856 DOI: 10.1186/s12879-020-05291-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/26/2020] [Indexed: 11/21/2022] Open
Abstract
Background Fungal bloodstream infections (FBI) among intensive care unit (ICU) patients are increasing. Our objective was to characterize the fungal pathogens that cause bloodstream infections and determine the epidemiology and risk factors for patient mortality among ICU patients in Meizhou, China. Methods Eighty-one ICU patients with FBI during their stays were included in the study conducted from January 2008 to December 2017. Blood cultures were performed and the antimicrobial susceptibility profiles of the resulting isolates were determined. Logistic multiple regression and ROC curve analysis were used to assess the risk factors for mortality among the cases. Results The prevalence of FBI in ICU patients was 0.38% (81/21,098) with a mortality rate of 36% (29/81). Ninety-eight strains of bloodstream-infecting fungi, mainly Candida spp., were identified from these patients. Candida albicans was most common (43%). Two strains of C. parapsilosis were no-sensitive to caspofungin, C. glabrata were less than 80% sensitive to azole drugs. Logistic multiple regression showed that age, serum albumin, APACHE II score, three or more underlying diseases, and length of stay in ICU were independent risk factors for mortality in FBI. ROC curve analysis showed that APACHE II scores > 19 and serum albumin ≤25 g/L were the best predictors of mortality. Conclusion Candida spp. predominated with high mortality rates among cases of FBI in ICU. Thus, clinical staff should enhance overall patient monitoring and concurrently monitor fungal susceptibility to reduce mortality rates.
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Affiliation(s)
- Guangwen Xiao
- Medical College, Jiaying University, Meizhou, People's Republic of China.
| | - Wanqing Liao
- Shanghai Key Laboratory of Medical Fungal Molecular Biology, Shanghai, People's Republic of China.
| | - Yuenong Zhang
- The First Department of Anesthesiology, People's Hospital of Meizhou, Meizhou, People's Republic of China
| | - Xiaodong Luo
- Medical College, Jiaying University, Meizhou, People's Republic of China
| | - Cailing Zhang
- Department of Anesthesiology, Chinese Medical Hospital of Meizhou, Meizhou, People's Republic of China
| | - Guodan Li
- Medical College, Jiaying University, Meizhou, People's Republic of China
| | - Yingping Yang
- Medical College, Jiaying University, Meizhou, People's Republic of China
| | - Yunyao Xu
- Department of Cardiology, Yuedong Hospital the Third Affiliated Hospital of Sun Yat-Sen University, Meizhou, People's Republic of China
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Santolaya ME, Thompson L, Benadof D, Tapia C, Legarraga P, Cortés C, Rabello M, Valenzuela R, Rojas P, Rabagliati R. A prospective, multi-center study of Candida bloodstream infections in Chile. PLoS One 2019; 14:e0212924. [PMID: 30849092 PMCID: PMC6407853 DOI: 10.1371/journal.pone.0212924] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/12/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Active surveillance is necessary for improving the management and outcome of patients with candidemia. The aim of this study was to describe epidemiologic and clinical features of candidemia in children and adults in tertiary level hospitals in Chile. METHODS We conducted a prospective, multicenter, laboratory-based survey study of candidemia in 26 tertiary care hospitals in Chile, from January 2013 to October 2017. RESULTS A total of 780 episodes of candidemia were included, with a median incidence of 0.47/1,000 admissions. Demographic, clinical and microbiological information of 384 cases of candidemia, from 18 hospitals (7,416 beds), was included in this report. One hundred and thirty-four episodes (35%) occurred in pediatric patients and 250 (65%) in adult population. Candida albicans (39%), Candida parapsilosis (30%) and Candida glabrata (10%) were the leading species, with a significant difference in the distribution of species between ages. The use of central venous catheter and antibiotics were the most frequent risk factors in all age groups (> 70%). Three hundred and fifteen strains were studied for antifungal susceptibility; 21 strains (6.6%) were resistant to fluconazole, itraconazole, voriconazole, anidulafungin or micafungin. The most commonly used antifungal therapies were fluconazole (39%) and echinocandins (36%). The overall 30-day survival was 74.2%, significantly higher in infants (82%) and children (86%) compared with neonates (72%), adults (71%) and elderly (70%). CONCLUSIONS Our prospective, multicenter surveillance study showed a low incidence of candidemia in Chile, with high 30-day survival, a large proportion of elderly patients, C. glabrata as the third most commonly identified strain, a 6.6% resistance to antifungal agents and a frequent use of echinocandins.
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Affiliation(s)
- Maria E. Santolaya
- Infectious Diseases Unit, Department of Pediatrics, Hospital Dr. Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Chilean Invasive Mycosis Network, Santiago, Chile
- * E-mail:
| | - Luis Thompson
- Chilean Invasive Mycosis Network, Santiago, Chile
- Infectious Diseases Unit, Department of Medicine, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Dona Benadof
- Chilean Invasive Mycosis Network, Santiago, Chile
- Microbiology Laboratory, Hospital Dr. Roberto del Río, Santiago, Chile
| | - Cecilia Tapia
- Chilean Invasive Mycosis Network, Santiago, Chile
- Microbiological and Micological Program, Instituto de Ciencias Biomédicas, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Paulette Legarraga
- Chilean Invasive Mycosis Network, Santiago, Chile
- Department of Clinical Laboratories, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia Cortés
- Chilean Invasive Mycosis Network, Santiago, Chile
- Medicine Department, Hospital San Borja Arriarán, Clínica Santa María, Faculty of Medicine, Universidad de Chile, Santiago Chile
| | - Marcela Rabello
- Infectious Diseases Unit, Department of Pediatrics, Hospital Dr. Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Chilean Invasive Mycosis Network, Santiago, Chile
| | - Romina Valenzuela
- Infectious Diseases Unit, Department of Pediatrics, Hospital Dr. Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Chilean Invasive Mycosis Network, Santiago, Chile
| | - Pamela Rojas
- Chilean Invasive Mycosis Network, Santiago, Chile
- Microbiology Laboratory, Hospital Padre Hurtado, Santiago, Chile
| | - Ricardo Rabagliati
- Chilean Invasive Mycosis Network, Santiago, Chile
- Department of Infectious Diseases, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Doi AM, Pignatari ACC, Edmond MB, Marra AR, Camargo LFA, Siqueira RA, da Mota VP, Colombo AL. Epidemiology and Microbiologic Characterization of Nosocomial Candidemia from a Brazilian National Surveillance Program. PLoS One 2016; 11:e0146909. [PMID: 26808778 PMCID: PMC4726651 DOI: 10.1371/journal.pone.0146909] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 12/23/2015] [Indexed: 01/06/2023] Open
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.
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Affiliation(s)
- André Mario Doi
- Department of Medicine, Division of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Michael B. Edmond
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
| | | | - Luis Fernando Aranha Camargo
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Ricardo Andreotti Siqueira
- Department of Medicine, Division of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Arnaldo Lopes Colombo
- Department of Medicine, Division of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- * E-mail:
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