1
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Cavassin FB, Baú-Carneiro JL, de Araújo Motta F, Ville APM, Staszczak L, de Queiroz-Telles F. Amphotericin B in Pediatrics: Analysis by Age Stratification Suggests a Greater Chance of Adverse Events from 13 Months of Age Onwards. Paediatr Drugs 2022; 24:513-528. [PMID: 35849282 DOI: 10.1007/s40272-022-00523-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Amphotericin B deoxycholate (AMB-D) remains an antifungal agent with great therapeutic value in pediatric patients. The currrent consensus is that its use in neonates is safer than in older children. However, childhood presents different periods of development that deserve to be evaluated more precisely. Our goal was to assess the usage profile of AMB-D in stratified pediatric age groups, adapted according to the National Institute of Child Health and Human Development classification. METHODS This retrospective cross-sectional observational study was conducted at a Brazilian tertiary children's hospital between January 2014 and December 2019. Data of patients who received at least two doses of intravenous AMB-D while hospitalized were extracted from electronic health files. Information on patient demographics, underlying diseases and comorbidities, laboratory examinations, fungal infection diagnosis, and AMB-D use were gathered following specific criteria. Nonparametric tests were applied, such as the chi-square test to compare proportions and Fisher's exact test to assess the association between categorical variables or contingency tables. RESULTS One hundred and twenty-seven (127) medical records were stratified as preterm neonatal (birth <37 weeks postmenstrual age), term neonatal (birth-27 days), infants (28 days-12 months), toddlers (13 months-2 years), early childhood (3-5 years), middle childhood (6-11 years), and early adolescence (12-18 years). The criteria for the indication of AMB-D followed empirical use as the main indication (n = 74; 58.26%), proven and probable fungal infection (n = 39; 30.71%), and medical suspicion (n = 14; 11.02%). Candida spp. was the main etiologic agent isolated in cultures, with the highest frequency of C. albicans (n = 18; 40%), followed by Candida parapsilosis (n = 14; 31.11%), and Candida tropicalis (n = 6; 13.33%). Very few acute infusion-related adverse effects were observed during the administration of AMB-D in pediatric patients. We found an unfavorable impact of AMB-D use in patients from 13 months of age onwards suggesting this group as a turning point for a greater chance of adverse events, and not soon after the neonatal period. CONCLUSIONS Clinical or observational studies based on age stratification are essential to accurately elucidate whether potentially toxic drugs can be used safely in the pediatric population. Our search for a turning point was shown to contribute to the accuracy of the study, as it provided data on the impact of D-AMB in specific pediatric age groups.
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Affiliation(s)
- Francelise Bridi Cavassin
- Postgraduate Program in Internal Medicine and Health Sciences, Federal University of Paraná (UFPR), 181, General Carneiro Street, Curitiba, Brazil.
| | | | | | | | | | - Flávio de Queiroz-Telles
- Department of Public Health, Hospital de Clínicas, Federal University of Paraná (HC-UFPR), Curitiba, Brazil
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2
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Melo MC, Carvalho Neto APM, Maranhão TLGQ, Costa ES, Nascimento CMA, Cavalcanti MGS, Ferreira-Júnior GC, Rocha MAN, Silva KM, Santos Júnior CJ, Rocha TJM. Microbiological characteristics of bloodstream infections in a reference hospital in northeastern Brazil. BRAZ J BIOL 2021; 84:e253065. [PMID: 34817043 DOI: 10.1590/1519-6984.253065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/08/2021] [Indexed: 11/22/2022] Open
Abstract
Routine blood culture is used for the detection of bloodstream infections by aerobic and anaerobic bacteria and by common pathogenic yeasts. A retrospective study was conducted in a public hospital in Maceió-AL, by collecting data of all medical records with positive blood cultures. Out of the 2,107 blood cultures performed, 17% were positive with Staphylococcus coagulase negative (51.14%), followed by Staphylococcus aureus (11.21%) and Klebsiella pneumoniae (6.32%). Gram-positive bacteria predominated among positive blood cultures, highlighting the group of Staphylococcus coagulase-negative. While Gram-negative bacteria had a higher number of species among positive blood cultures.
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Affiliation(s)
- M C Melo
- Centro Universitário Cesmac, Maceió, AL, Brasil
| | | | | | - E S Costa
- Centro Universitário Cesmac, Maceió, AL, Brasil
| | | | | | - G C Ferreira-Júnior
- Instituto Federal de Educação, Ciência e Tecnologia do Acre - IFAC, Xapuri, AC, Brasil
| | - M A N Rocha
- Universidade Estadual de Alagoas - UNEAL, Arapiraca, AL, Brasil
| | - K M Silva
- Universidade Estadual de Ciências da Saúde de Alagoas - UNCISAL, Maceió, AL, Brasil
| | - C J Santos Júnior
- Universidade Estadual de Ciências da Saúde de Alagoas - UNCISAL, Maceió, AL, Brasil
| | - T J M Rocha
- Centro Universitário Cesmac, Maceió, AL, Brasil.,Universidade Estadual de Ciências da Saúde de Alagoas - UNCISAL, Maceió, AL, Brasil
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3
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Chen J, Hu N, Xu H, Liu Q, Yu X, Zhang Y, Huang Y, Tan J, Huang X, Zeng L. Molecular Epidemiology, Antifungal Susceptibility, and Virulence Evaluation of Candida Isolates Causing Invasive Infection in a Tertiary Care Teaching Hospital. Front Cell Infect Microbiol 2021; 11:721439. [PMID: 34604110 PMCID: PMC8479822 DOI: 10.3389/fcimb.2021.721439] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/09/2021] [Indexed: 01/08/2023] Open
Abstract
Background The incidence of invasive candidiasis is increasing worldwide. However, the epidemiology, antifungal susceptibility, and virulence of Candida spp. in most hospitals remain unclear. This study aimed to evaluate invasive candidiasis in a tertiary care hospital in Nanchang City, China. Methods MALDI-TOF MS and 18S rDNA ITS sequencing were used to identify Candida strains. Randomly amplified polymorphic DNA analysis was used for molecular typing; biofilm production, caseinase, and hemolysin activities were used to evaluate virulence. The Sensititre™ YeastOne YO10 panel was used to examine antifungal susceptibility. Mutations in ERG11 and the hotspot regions of FKS1 of drug-resistant strains were sequenced to evaluate the possible mechanisms of antifungal resistance. Results We obtained 110 Candida strains, which included 40 Candida albicans (36.36%), 37 C. parapsilosis (33.64%), 21 C. tropicalis (19.09%), 9 C. glabrata (8.18%), 2 C. rugose (1.82%), and 1 C. haemulonii (0.91%) isolates. At a limiting point of 0.80, C. albicans isolates could be grouped into five clusters, C. parapsilosis and C. tropicalis isolates into seven clusters, and C. glabrata isolates into only one cluster comprising six strains by RAPD typing. Antifungal susceptibility testing revealed that the isolates showed the greatest overall resistance against fluconazole (6.36%), followed by voriconazole (4.55%). All C. albicans and C. parapsilosis isolates exhibited 100% susceptibility to echinocandins (i.e., anidulafungin, caspofungin, and micafungin), whereas one C. glabrata strain was resistant to echinocandins. The most common amino acid substitutions noted in our study was 132aa (Y132H, Y132F) in the azole-resistant strains. No missense mutation was identified in the hotpot regions of FKS1. Comparison of the selected virulence factors detectable in a laboratory environment, such as biofilm, caseinase, and hemolysin production, revealed that most Candida isolates were caseinase and hemolysin producers with a strong activity (Pz < 0.69). Furthermore, C. parapsilosis had greater total biofilm biomass (average Abs620 = 0.712) than C. albicans (average Abs620 = 0.214, p < 0.01) or C. tropicalis (average Abs620 = 0.450, p < 0.05), although all C. glabrata strains were either low- or no-biofilm producers. The virulence level of the isolates from different specimen sources or clusters showed no obvious correlation. Interesting, 75% of the C. albicans from cluster F demonstrated azole resistance, whereas two azole-resistant C. tropicalis strains belonged to the cluster Y. Conclusion This study provides vital information regarding the epidemiology, pathogenicity, and antifungal susceptibility of Candida spp. in patients admitted to Nanchang City Hospital.
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Affiliation(s)
- Junzhu Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Department of Medical Microbiology, School of Medicine, Nanchang University, Nanchang, China
| | - Niya Hu
- Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hongzhi Xu
- Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Department of Preventive Medicine and Public Health, School of Public Health, Nanchang University, Nanchang, China
| | - Qiong Liu
- Department of Medical Microbiology, School of Medicine, Nanchang University, Nanchang, China
| | - Xiaomin Yu
- Department of Medical Microbiology, School of Medicine, Nanchang University, Nanchang, China
| | - Yuping Zhang
- Department of Medical Microbiology, School of Medicine, Nanchang University, Nanchang, China
| | - Yongcheng Huang
- Department of Preventive Medicine and Public Health, School of Public Health, Nanchang University, Nanchang, China
| | - Junjun Tan
- Department of Medical Microbiology, School of Medicine, Nanchang University, Nanchang, China
| | - Xiaotian Huang
- Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Department of Medical Microbiology, School of Medicine, Nanchang University, Nanchang, China
| | - Lingbing Zeng
- Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Department of Preventive Medicine and Public Health, School of Public Health, Nanchang University, Nanchang, China
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Paixao de Sousa da Silva AM, de Moraes-Pinto MI, Teofilo Pignati L, Barbosa Teixeira B, Cordeiro Lima AP, Costa Pimentel Germano P, Petrilli AS, Marques LMA, Carlesse F. Candida spp bloodstream infections in a Latin American Pediatric Oncology Reference Center: Epidemiology and associated factors. Mycoses 2020; 63:812-822. [PMID: 32428294 DOI: 10.1111/myc.13106] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Invasive fungal disease is a significant cause of morbidity and mortality in immunosuppressed children. The recognition of patients at risk for candidaemia is paramount to a better prognosis. OBJECTIVES To characterize Candida spp bloodstream infections (BSI) in a reference centre for paediatric oncology and to describe the most prevalent risk factors associated with candida infections. PATIENTS/METHODS This is a retrospective cohort study carried out with paediatric patients followed up with at the Institute of Pediatric Oncology, Brazil, who presented positive blood culture for Candida spp from January 2004 to December 2016. RESULTS Ninety episodes of candidaemia were analysed; patients had a median age of 4.5 years, and 57.8% were males, with a diagnosis of solid tumours in 54.5% of cases. The most common Candida species were C albicans (35.6%), C parapsilosis (30.0%) and C tropicalis (16.7%). C tropicalis BSI was associated with neutropenia and skin lesions. Therapy was successful in 67.1% of the episodes. Older age and thrombocytopenia were associated with therapeutic failure. Death within 30 days occurred in 24.4% of patients; predictive factors were older age and admission to an ICU C parapsilosis candidaemia was a protective factor for death when compared to C albicans. CONCLUSION The main species isolated were C albicans, C parapsilosis and C tropicalis. C tropicalis BSI was associated with neutropenia and skin lesions. The death rate was significant, and a worse prognosis was associated with older age, thrombocytopenia and admission to an ICU C parapsilosis infection proved to be a protective factor against mortality.
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Affiliation(s)
- Adriana Maria Paixao de Sousa da Silva
- Division of Pediatric Infectious Diseases, Federal University of Sao Paulo, Sao Paulo, Brazil.,Institute of Pediatric Oncology, Grupo de Apoio ao Adolescente e Criança com Câncer, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Luara Teofilo Pignati
- Division of Pediatric Infectious Diseases, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Bruno Barbosa Teixeira
- Division of Pediatric Infectious Diseases, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Ana Paula Cordeiro Lima
- Institute of Pediatric Oncology, Grupo de Apoio ao Adolescente e Criança com Câncer, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Priscila Costa Pimentel Germano
- Institute of Pediatric Oncology, Grupo de Apoio ao Adolescente e Criança com Câncer, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Antonio Sergio Petrilli
- Division of Pediatric Infectious Diseases, Federal University of Sao Paulo, Sao Paulo, Brazil.,Institute of Pediatric Oncology, Grupo de Apoio ao Adolescente e Criança com Câncer, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Leticia Maria Acioli Marques
- Division of Pediatric Infectious Diseases, Federal University of Sao Paulo, Sao Paulo, Brazil.,Institute of Pediatric Oncology, Grupo de Apoio ao Adolescente e Criança com Câncer, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Fabianne Carlesse
- Division of Pediatric Infectious Diseases, Federal University of Sao Paulo, Sao Paulo, Brazil.,Institute of Pediatric Oncology, Grupo de Apoio ao Adolescente e Criança com Câncer, Federal University of Sao Paulo, Sao Paulo, Brazil
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5
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Jiang J, Liang QL, Liu LH, Cai SQ, Du ZY, Kong JL, Chen YQ. Septic pulmonary embolism in China: clinical features and analysis of prognostic factors for mortality in 98 cases. BMC Infect Dis 2019; 19:1082. [PMID: 31881849 PMCID: PMC6935238 DOI: 10.1186/s12879-019-4672-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/29/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To investigate the clinical features of septic pulmonary embolism (SPE) cases and prognostic factors for in-hospital mortality in China. METHODS A retrospective analysis was conducted of SPE patients hospitalized between January 2007 and June 2018 in the Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University. RESULTS A total of 98 patients with SPE were identified. All patients had bilateral multiple peripheral nodules on chest computed tomography. The most common pathogen found in blood culture was Staphylococcus aureus (10/33, 30.3%). Transthoracic echocardiography was performed in 39 patients and 20 showed vegetations. Bronchoscopy was performed in 24 patients. Bronchoalveolar lavage fluid (BALF) was obtained from 15 patients (62.5%) and showed predominantly polymorphonuclear cell infiltration (52%, range of 48%~ 63%). Four patients received transbronchial lung biopsy, and histopathological examinations revealed suppurative pneumonia and organizing pneumonia. The in-hospital mortality rate was 19.4%. Age (odds ratio [OR] 1.100; 95% confidence interval [CI] 1.035-1.169), hypotension (OR 7.260; 95% CI 1.126-46.804) and ineffective or delay of empirical antimicrobial therapy (OR 7.341; 95% CI 1.145-47.045) were found to be independent risk factors for in-hospital mortality, whereas drainage treatment was found to be a protective factor (OR 0.33; 95% CI 0.002-0.677). CONCLUSIONS SPE cases presented with nonspecific clinical manifestations and radiologic features. Blood cultures and bronchoscopy are important measures for early diagnosis and differential diagnosis. There is relationship between primary infection sites and the type of pathogen. Maintaining normal blood pressure and providing timely and appropriate initial antimicrobial therapy for effective control of the infection could improve prognosis.
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Affiliation(s)
- Jing Jiang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
| | - Qiu-li Liang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
| | - Li-hua Liu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
| | - Shuang-qi Cai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
| | - Zhong-ye Du
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
| | - Jin-liang Kong
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
| | - Yi-qiang Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
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6
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da Silva RB, Neves RP, Hinrichsen SL, de Lima-Neto RG. Candidemia in a public hospital in Northeastern Brazil: Epidemiological features and risk factors in critically ill patients. Rev Iberoam Micol 2019; 36:181-185. [PMID: 31759839 DOI: 10.1016/j.riam.2019.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 06/03/2019] [Accepted: 06/13/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Candidemia is a life-threatening fungal infection characterized by the presence of Candida in the blood. AIMS To describe the clinical-epidemiological features and main risk factors among patients with candidemia admitted to Intensive Care Unit. METHODS A cross-sectional, retrospective and observational study was performed between January 2015 and July 2016. Laboratory reports and medical records from ICU patients admitted to a public hospital in northeastern Brazil were analyzed. RESULTS There were 1573 admissions and 67 of them were positive for candidemia. The majority of patients were male (53.3%) and remained at the hospital for more than seven days (86.6%). Non-C. albicansCandida infections (60%) were predominant. Broad-spectrum antibiotic therapy was prescribed in 98.4% of the cases. The most frequent underlying diseases were sepsis (73.3%), presence of solid tumors (15%), respiratory condition (60%), urinary tract disease (56.6%) and gastrointestinal tract diseases (23.3%). Surgeries were carried out on 43% of the patients, consisting of 23.3% abdominal surgeries, with a mortality rate of 92.8%. Risk factors were venous central access (93.3%), mechanical ventilation (81.6%), nasoenteral tube (83.3%), nasogastric tube (25%), indwelling bladder catheter (88.3%), diabetes mellitus (55%) and tracheostomy (36.6%). Statistical analysis correlated the use of indwelling bladder catheter with a higher mortality rate (r=0.07412, p=0.0353). CONCLUSIONS The current study reveals the high case fatality rates among critically ill patients suffering from candidemia admitted to ICU. Herein, we highlight the importance of identifying non-C. albicansCandida species and reinforce the idea of carrying out epidemiological surveillances and antifungal susceptibility tests.
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Affiliation(s)
- Renata Baltar da Silva
- Hospital das Clínicas de Pernambuco (HC/PE), Brazil; Nucleus of Education, Research and Assistance in Infectious Diseases, HC/PE, Brazil
| | - Rejane Pereira Neves
- Department of Mycology, Biosciences Center, Federal University of Pernambuco (UFPE), Brazil; Department of Tropical Medicine, Center of Health Science, UFPE, Brazil; Nucleus of Education, Research and Assistance in Infectious Diseases, HC/PE, Brazil
| | - Sylvia Lemos Hinrichsen
- Department of Tropical Medicine, Center of Health Science, UFPE, Brazil; Nucleus of Education, Research and Assistance in Infectious Diseases, HC/PE, Brazil
| | - Reginaldo Gonçalves de Lima-Neto
- Department of Tropical Medicine, Center of Health Science, UFPE, Brazil; Nucleus of Education, Research and Assistance in Infectious Diseases, HC/PE, Brazil.
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7
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Revisiting Species Distribution and Antifungal Susceptibility of Candida Bloodstream Isolates from Latin American Medical Centers. J Fungi (Basel) 2017; 3:jof3020024. [PMID: 29371542 PMCID: PMC5715916 DOI: 10.3390/jof3020024] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/12/2017] [Accepted: 05/12/2017] [Indexed: 02/03/2023] Open
Abstract
The epidemiology of candidemia varies geographically, and there is still scarce data on the epidemiology of candidemia in Latin America (LA). After extensive revision of medical literature, we found reliable and robust information on the microbiological aspects of candidemia in patients from 11 out of 21 medical centers from LA countries and 1 out of 20 from Caribbean countries/territories. Based on 40 papers attending our search strategy, we noted that C. albicans remains the most common species causing candidemia in our region, followed by C. parapsilosis and C. tropicalis. In Argentina, Brazil, and Colombia, a trend towards an increase in frequency of C. glabrata candidemia was observed. Although resistance rates to fluconazole is under 3%, there was a slight increase in the resistance rates to C. albicans, C. parapsilosis and C. tropicalis isolates. Echinocandin resistance has been reported in a few surveys, but no single study confirmed the resistant phenotype reported by using molecular methods. We highlight the importance of conducting continuous surveillance studies to identify new trends in terms of species distribution of Candida and antifungal resistance related to episodes of candidemia in LA. This information is critical for helping clinicians to prevent and control Candida bloodstream infections in their medical centers.
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8
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Risk Adjustment for Congenital Heart Surgery Score as a Risk Factor for Candidemia in Children Undergoing Congenital Heart Defect Surgery. Pediatr Infect Dis J 2016; 35:1194-1198. [PMID: 27753765 DOI: 10.1097/inf.0000000000001277] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Candida species are the primary cause of invasive fungal infection in hospitalized children. There are few data on risk factors for postoperative candidemia in pediatric patients with congenital heart defects. This study aimed to identify risk factors for candidemia in patients with congenital heart defects who underwent cardiac surgery. METHODS This was a case-control study conducted in patients admitted to a pediatric cardiology intensive care unit from January 2006 to December 2013. Candidemia cases were matched with control patients without candidemia. Multivariate analyses were conducted to determine predictive probabilities for the incidence of candidemia at a risk higher than 10%. RESULTS Thirty patients diagnosed with candidemia (incidence: 0.7 cases/1000 patient days) were matched with 75 controls. Risk factors independently associated with candidemia included Risk Adjustment for Congenital Heart Surgery (RACHS-1) category ≥3 [odds ratio (OR) = 3.165, 95% confidence interval: 1.377-8.467], use of acid suppression therapy (OR = 1.9, 95% confidence interval: 0.949-3.979) and thrombocytopenia (OR = 2.2, 95% confidence interval: 1.2-4.2). Predictive probabilities ranged from 11% (only in RACHS-1 category ≥3) to 58% (combined RACHS-1 ≥3, thrombocytopenia and acid suppression therapy use). The case fatality rate within 30 days after candidemia was 50%. CONCLUSION This is the first report using the RACHS-1 category as a risk factor for invasive candidiasis in patients with congenital heart defects in the pediatric intensive care unit. Further studies must be conducted to validate the risk factors for candidemia in this pediatric population.
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9
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Important Mycoses in Children in South America. CURRENT FUNGAL INFECTION REPORTS 2016. [DOI: 10.1007/s12281-016-0249-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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10
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Herkert PF, Gomes RR, Muro MD, Pinheiro RL, Fornari G, Vicente VA, Queiroz-Telles F. In vitro susceptibility and molecular characterization of Candida spp. from candidemic patients. Rev Iberoam Micol 2015; 32:221-8. [DOI: 10.1016/j.riam.2014.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 07/01/2014] [Accepted: 07/15/2014] [Indexed: 10/24/2022] Open
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11
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Santos ERD, Dal Forno CF, Hernandez MG, Kubiça TF, Venturini TP, Chassot F, Santurio JM, Alves SH. Susceptibility of Candida spp. isolated from blood cultures as evaluated using the M27-A3 and new M27-S4 approved breakpoints. Rev Inst Med Trop Sao Paulo 2015; 56:477-82. [PMID: 25351540 PMCID: PMC4296866 DOI: 10.1590/s0036-46652014000600004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 04/22/2014] [Indexed: 12/16/2022] Open
Abstract
The high mortality rates associated with candidemia episodes and the
emergence of resistance to antifungal agents necessitate the monitoring of the
susceptibility of fungal isolates to antifungal treatments. The new, recently
approved, species-specific clinical breakpoints
(SS-CBPs)(M27-S4) for evaluating susceptibility require
careful interpretation and comparison with the former proposals made using the
M27-A3 breakpoints, both from CLSI. This study evaluated the susceptibility of
the different species of Candida that were isolated from
candidemias based on these two clinical breakpoints. Four hundred and twenty-two
isolates were identified and, among them, C. parapsilosis
comprised 46.68%, followed by C. albicans
(35.78%), C. tropicalis (9.71%),
C. glabrata (3.55%), C.
lusitaniae (1.65%), C.
guilliermondii (1.65%) and C.
krusei (0.94%). In accordance with the M27-A3
criteria, 33 (7.81%) non-susceptible isolates were identified, of
which 16 (3.79%) were resistant to antifungal agents. According
to SS-CBPs, 80 (18.95%) isolates were non-susceptible, and 10
(2.36%) of these were drug resistant. When the total number of
non-susceptible isolates was considered, the new SS-CBPs detected 2.4 times the
number of isolates that were detected using the M27-A3 interpretative criteria.
In conclusion, the detection of an elevated number of non-susceptible species
has highlighted the relevance of evaluating susceptibility tests using new,
species-specific clinical breakpoints (SS-CBPs), which could impact
the profile of non-susceptible Candida spp. to antifungal
agents that require continuous susceptibility monitoring.
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Affiliation(s)
- Edileusa Rosa dos Santos
- Post-Graduate Program in Pharmaceutical Sciences, Health Science Center, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | | | - Mari Glei Hernandez
- Post-Graduate Program in Pharmaceutical Sciences, Health Science Center, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Thaís Felli Kubiça
- Post-Graduate Program in Pharmaceutical Sciences, Health Science Center, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Tarcieli P Venturini
- Post-Graduate Program in Pharmaceutical Sciences, Health Science Center, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Francieli Chassot
- Post-Graduate Program in Pharmaceutical Sciences, Health Science Center, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Janio M Santurio
- Departament of Microbiology and Parasitology, Federal University of Santa Maria, Santa Maria, RS, Brazil
| | - Sydney Hartz Alves
- Post-Graduate Program in Pharmaceutical Sciences, Health Science Center, Federal University of Santa Maria, Santa Maria, RS, Brazil
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Magalhães YC, Bomfim MRQ, Melônio LC, Ribeiro PCS, Cosme LM, Rhoden CR, Marques SG. Clinical significance of the isolation of Candida species from hospitalized patients. Braz J Microbiol 2015. [PMID: 26221096 PMCID: PMC4512074 DOI: 10.1590/s1517-838246120120296] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In this study, we isolated and phenotypically identified 108 yeast strains from various clinical specimens collected from 100 hospitalized patients at three tertiary hospitals in São Luís-Maranhão, Brazil, from July to December 2010. The isolates were analyzed for their susceptibility to four of the most widely used antifungal agents in the surveyed hospitals, amphotericin B, fluconazole, 5-flucytosine and voriconazole. The species identified were Candida albicans (41.4%), Candida tropicalis (30.1%), C. glabrata (7.4%), Candida parapsilosis (5.5%), Candida krusei (4.6%), Cryptococcus neoformans (4.6%), Trichosporon spp . (3.7%), Candida norvegensis (0.9%), Rhodotorula glutinis (0.9%) and Pichia farinosa (0.9%). A higher isolation rate was observed in the following clinical specimens: urine (54 isolates; 50%), respiratory tract samples (21 isolates; 19.4%) and blood (20 isolates; 18.6%). Candida albicans isolates were 100% sensitive to all antifungal agents tested, whereas Candida krusei and Crytococcus neoformans displayed intermediate resistance to 5-flucytosine, with Minimal Inhibitory Concentration (MIC) values of 8 mg/mL and 16 mg/mL, respectively. Both strains were also S-DD to fluconazole with an MIC of 16 mg/mL. C. tropicalis was resistant to 5-flucytosine with an MIC of 32 μg/mL. This study demonstrates the importance of identifying the yeast species involved in community and nosocomial infections.
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Affiliation(s)
| | | | | | - Patrícia C S Ribeiro
- Laboratório Cedro, São Luis, MA, Brazil. ; Universidade CEUMA, São Luis, MA, Brazil. ; Hospital Universitário, Universidade Federal do Maranhão, São Luis, MA, Brazil
| | - Lécia M Cosme
- Laboratório Cedro, São Luis, MA, Brazil. ; Laboratório Central de Saúde Pública do Maranhão, São Luis, MA, Brazil
| | | | - Sirlei G Marques
- Laboratório Cedro, São Luis, MA, Brazil. ; Universidade CEUMA, São Luis, MA, Brazil. ; Hospital Universitário, Universidade Federal do Maranhão, São Luis, MA, Brazil
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13
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Francischetto O, Silva LAPD, Senna KMSE, Vasques MR, Barbosa GF, Weksler C, Ramos RG, Golebiovski WF, Lamas CDC. Healthcare-associated infective endocarditis: a case series in a referral hospital from 2006 to 2011. Arq Bras Cardiol 2014; 103:292-8. [PMID: 25352503 PMCID: PMC4206359 DOI: 10.5935/abc.20140126] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 05/05/2014] [Indexed: 11/20/2022] Open
Abstract
Background Healthcare-associated infective endocarditis (HCA-IE), a severe complication of
medical care, shows a growing incidence in literature. Objective To evaluate epidemiology, etiology, risk factors for acquisition, complications,
surgical treatment, and outcome of HCA-IE. Methods Observational prospective case series study (2006-2011) in a public hospital in
Rio de Janeiro. Results Fifty-three patients with HCA-IE from a total of 151 cases of infective
endocarditis (IE) were included. There were 26 (49%) males (mean age of 47
± 18.7 years), 27 (51%) females (mean age of 42 ± 20.1 years). IE
was acute in 37 (70%) cases and subacute in 16 (30%) cases. The mitral valve was
affected in 19 (36%) patients and the aortic valve in 12 (36%); prosthetic valves
were affected in 23 (43%) patients and native valves in 30 (57%). Deep intravenous
access was used in 43 (81%) cases. Negative blood cultures were observed in 11
(21%) patients, Enterococcus faecalis in 10 (19%),
Staphylococcus aureus in 9 (17%), and Candida sp. in 7 (13%).
Fever was present in 49 (92%) patients, splenomegaly in 12 (23%), new
regurgitation murmur in 31 (58%), and elevated C-reactive protein in 44/53 (83%).
Echocardiograms showed major criteria in 46 (87%) patients, and 34 (64%) patients
were submitted to cardiac surgery. Overall mortality was 17/53 (32%). Conclusion In Brazil HCA-IE affected young subjects. Patients with prosthetic and native
valves were affected in a similar proportion, and non-cardiac surgery was an
infrequent predisposing factor, whereas intravenous access was a common one. S.
aureus was significantly frequent in native valve HCA-IE, and overall mortality
was high.
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Affiliation(s)
| | | | | | | | | | - Clara Weksler
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brasil
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da Costa VG, Quesada RMB, Abe ATS, Furlaneto-Maia L, Furlaneto MC. Nosocomial bloodstream Candida infections in a tertiary-care hospital in South Brazil: a 4-year survey. Mycopathologia 2014; 178:243-50. [PMID: 25103140 DOI: 10.1007/s11046-014-9791-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 07/28/2014] [Indexed: 10/24/2022]
Abstract
The aims of this study were to evaluate the epidemiology of nosocomial candidemia in a tertiary hospital in South Brazil and the in vitro antifungal susceptibility of isolates. Blood strains from 108 patients were identified by PCR-based method. Some 30.5 % of candidemia were caused by Candida tropicalis, 28.7 % were due to Candida albicans, 24.1 % with Candida parapsilosis sensu stricto, 8.3 % with Candida glabrata sensu lato, 1.8 % involved Candida krusei and 6.6 % with other species. Candidemia was more common in intensive care unit settings (66 %). In vitro susceptibility to antifungal drugs was determined by a microdilution method; and new species-specific clinical breakpoints for fluconazole and voriconazole were applied. Overall susceptibility rates were 100 % for itraconazole, 91 % for fluconazole, 98 % for voriconazole and 99 % for amphotericin B. Fluconazole resistance was mostly among C. parapsilosis sensu stricto isolates (26.9 %). Most of the findings reported here agreed with epidemiological features common to other tertiary hospitals in Brazil; but also revealed some peculiarities, such as a high frequency of C. tropicalis associated with candidemia. Besides, high rate of fluconazole resistance among C. parapsilosis stricto sensu isolates was obtained when applying the new species-specific clinical breakpoints.
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Affiliation(s)
- Viviane Gevezier da Costa
- Department of Microbiology, Centre of Biological Sciences, Paraná State University, C.P. 6001, Londrina, PR, CEP: 86051990, Brazil
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15
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Wille MP, Guimarães T, Furtado GHC, Colombo AL. Historical trends in the epidemiology of candidaemia: analysis of an 11-year period in a tertiary care hospital in Brazil. Mem Inst Oswaldo Cruz 2014; 108:S0074-02762013000300288. [PMID: 23778668 DOI: 10.1590/s0074-02762013000300005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 12/07/2012] [Indexed: 02/12/2023] Open
Abstract
Candida species are an important cause of bloodstream infections (BSI). To evaluate the epidemiological, clinical and microbiological aspects of two cohorts {1994-1999 [period 1 (P1) ]; 2000-2004 [period 2 (P2) ]} of candidaemic patients, we performed a retrospective analysis from a laboratory-based survey. A total of 388 candidaemias were identified, with an incidence of 0.20/1,000 patient-days and a significant increase in P2 vs. P1 (0.25 vs. 0.15, p = 0.04). Cancer and prior antibiotic use were frequent and Candida albicans was the most prevalent species found (42.4%). Resistance to fluconazole was found in 2.47% of the strains. No differences were observed in the species distribution of Candida during the study periods. In the P2 cohort, there were higher prevalence of elderly individuals, cardiac, pulmonary and liver diseases, renal failure, central venous catheters and antibiotic therapy. In P1, there were higher prevalence of neurological diseases and chemotherapy. The crude mortality was 55.4%. In conclusion, our incidence rates remained high. Furthermore, the distribution pattern of Candida species and the fluconazole resistance profile remained unchanged. Moreover, we found a clear trend of higher prevalence of candidaemia among the elderly and among patients with comorbidities. Finally, it is necessary to discuss strategies for the prevention and control of Candida BSI in Brazil.
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Affiliation(s)
- Marcos Paulo Wille
- Laboratório Especializado em Micologia, Comissão de Controle de Infecção Hospitalar, São Paulo, SP, Brasil
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16
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Hoffmann-Santos HD, Paula CR, Yamamoto ACA, Tadano T, Hahn RC. Six-year trend analysis of nosocomial candidemia and risk factors in two intensive care hospitals in Mato Grosso, midwest region of Brazil. Mycopathologia 2013; 176:409-15. [PMID: 24113801 DOI: 10.1007/s11046-013-9705-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Abstract
We conducted this cross-sectional retrospective study using clinical and laboratory data from two tertiary hospitals in Cuiabá, Mato Grosso, Brazil, in order to explore the risk factors and estimate mortality, prevalence and lethality of candidemia between 2006 and 2011. A total of 130 episodes of candidemia were identified. The prevalence of candidemia was 1.8 per 1,000 admissions, the mortality rate was 0.9 per 1,000 admissions, and the lethality was 49.2 %. The main agent in this population was Candida parapsilosis (n = 50), followed by C. albicans (n = 45). Comparison between the numbers of episodes in the two triennia revealed that the non-albicans group grew by 48.2 %. The distribution of yeast species of Candida per hospital unit revealed that C. albicans was more prevalent than C. parapsilosis in the adult ICU and C. parapsilosis was more prevalent than C. albicans in the neonatal ICU. Patients remained hospitalized for an average of 53.5 days. Central venous catheters, parenteral nutrition and age were the variables that proved to be independent in the multivariate analysis and that maintained a statistically significant association with the incidence of death in patients with candidemia. The annual prevalence of candidemia showed a significant increase in the second triennium (2009-2011) compared with the first (2006-2008) probably due to increased exposure to risk factors: central venous catheter, H2 blockers, nutrition parenteral corticosteroids and mean hospital duration.
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Affiliation(s)
- Hugo Dias Hoffmann-Santos
- Laboratório de Micologia, Faculdade de Medicina, Universidade Federal de Mato Grosso, Av. Fernando Correa da Costa, No. 2367, bairro Boa Esperança, Cuiabá, MT, CEP 78060-900, Brazil
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17
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Ferreira AV, Prado CG, Carvalho RR, Dias KST, Dias ALT. Candida albicans and non-C. albicans Candida species: comparison of biofilm production and metabolic activity in biofilms, and putative virulence properties of isolates from hospital environments and infections. Mycopathologia 2013; 175:265-72. [PMID: 23532754 DOI: 10.1007/s11046-013-9638-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 03/11/2013] [Indexed: 11/26/2022]
Abstract
Candida albicans and, more recently, non-C. albicans Candida spp. are considered the most frequent fungi in hospitals. This study analyzed Candida spp. isolates and compared the frequency of different species, that is, C. albicans and non-C. albicans Candida spp., and the origins of isolates, that is, from hospital environments or infections. Yeast virulence factors were evaluated based on biofilm production and metabolic activity. Hemolysin production and the antifungal susceptibility profiles of isolates were also evaluated. Candida spp. were highly prevalent in samples collected from hospital environments, which may provide a reservoir for continuous infections with these yeasts. There were no differences in the biofilm productivity levels and metabolic activities of the environmental and clinical isolates, although the metabolic activities of non-C. albicans Candida spp. biofilms were greater than those of the C. albicans biofilms (p < 0.05). Clinical samples had higher hemolysin production (p < 0.05) and lower susceptibility to fluconazole (p < 0.05). Non-C. albicans Candida spp. predominated in samples collected from hospital environments and infections (p < 0.05). These species had a lower susceptibility to fluconazole and amphotericin B, and their biofilms had higher metabolic activities than those produced by C. albicans, which may explain the increased incidence of fungal infections with these yeasts during recent years.
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Affiliation(s)
- A V Ferreira
- Microbiology and Immunology Department, Biomedical Sciences Institute, Federal University of Alfenas (UNIFAL-MG), Alfenas, MG, Brazil
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Godoy JSR, de Souza Bonfim-Mendonça P, Nakamura SS, Yamada SS, Shinobu-Mesquita C, Pieralisi N, Fiorini A, Svidzinski TIE. Colonization of the oral cavity by yeasts in patients with chronic renal failure undergoing hemodialysis. J Oral Pathol Med 2012; 42:229-34. [DOI: 10.1111/jop.12003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Janine S. R. Godoy
- Section of Medical Mycology; Department of Clinical Analysis; State University of Maringá; Maringá Parana Brazil
| | | | - Sandra S. Nakamura
- Section of Medical Mycology; Department of Clinical Analysis; State University of Maringá; Maringá Parana Brazil
| | - Sérgio S. Yamada
- Department of Medicine; State University of Maringá; Maringá Parana Brazil
| | - Cristiane Shinobu-Mesquita
- Section of Medical Mycology; Department of Clinical Analysis; State University of Maringá; Maringá Parana Brazil
| | - Neli Pieralisi
- Department of Dentistry; State University of Maringá; Maringá Parana Brazil
| | - Adriana Fiorini
- Section of Medical Mycology; Department of Clinical Analysis; State University of Maringá; Maringá Parana Brazil
| | - Terezinha I. E. Svidzinski
- Section of Medical Mycology; Department of Clinical Analysis; State University of Maringá; Maringá Parana Brazil
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Ten-Year Study of Species Distribution and Antifungal Susceptibilities of Candida Bloodstream Isolates at a Brazilian Tertiary Hospital. Mycopathologia 2012; 174:389-96. [DOI: 10.1007/s11046-012-9566-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 07/03/2012] [Indexed: 10/28/2022]
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20
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Akeme Yamamoto AC, de Paula CR, Dias LB, Tadano T, Martins ÉR, Amadio JVRDS, Hahn RC. Epidemiological and clinical characteristics of nosocomial candidiasis in university hospitals in Cuiabá--Mato Grosso, Brazil. Rev Iberoam Micol 2012; 29:164-8. [PMID: 22285886 DOI: 10.1016/j.riam.2012.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 12/01/2011] [Accepted: 01/12/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Fungal infections are emerging as an important cause of human disease, especially among hospitalized patients with serious underlying disease and several risk factors. AIMS To evaluate epidemiological and clinical characteristics of patients with nosocomial candidiasis in university hospitals in Cuiabá - MT, Brazil. METHODS A descriptive study of 91 patients admitted to university hospitals in Cuiabá - MT, with clinical and laboratory diagnosis of nosocomial candidiasis, over a 20-month period. RESULTS A rate for nosocomial infections by Candida spp. of 5 per 1000 admissions, proportional mortality of 14.4% and lethality of 53.8% were determined. The patient age ranged from 29 days to 82 years-old, among which, 74.7% were adults and 25.3% children. The intensive care units contributed with the highest number of cases of infection by Candida spp. (69.2%). The most important underlying disease was gastrointestinal tract disease (11%). Prematurity and low birth weight were the most important risk factors among newborns. The use of antibiotics, invasive procedures, H(2) blockers, multiple blood transfusions and stay length of ≥21 days were the most frequent risk factors among adults. Candida albicans was the most common species in all cases. CONCLUSIONS In this study, C. albicans was the most frequently detected species in candidiasis and risk factors increased the susceptibility of hospitalized patients to acquiring a nosocomial infection by Candida spp.
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Affiliation(s)
- Ana Caroline Akeme Yamamoto
- Investigation Laboratory (Mycology), Faculty of Medical Sciences, Federal University of Mato Grosso, Cuiabá, MT, Brazil
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In vitro susceptibility of a large collection of Candida Strains against fluconazole and voriconazole by using the CLSI disk diffusion assay. Mycopathologia 2010; 171:411-6. [PMID: 21181497 DOI: 10.1007/s11046-010-9387-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 12/03/2010] [Indexed: 10/18/2022]
Abstract
We evaluated all Candida spp. isolates obtained from patients admitted to two tertiary care hospitals between 1999 and 2003 in the city of São Paulo, Brazil. The in vitro activities of fluconazole (FCZ) and voriconazole were determined by the agar disk diffusion test using the Clinical and Laboratory Standards Institute M44-A guidelines. The inhibition zone diameters were read and interpreted automatically by the BIOMIC(®) image-analysis plate reader system. We tested a total of 4,625 strains, including 2,393 strains of C. albicans (51.7%), 658 of C. tropicalis (14.2%), 503 of C. glabrata (10.9%), 495 of C. parapsilosis (10.7%), 292 of C. rugosa (6.3%), 195 of C. guilliermondii (4.2%) and 89 of other Candida species (2.0%). Only 2.0% of the strains tested were classified as dose-dependent susceptible (DDS), and 5.8% of them were resistant to FCZ. The resistance or DDS to fluconazole was verified mainly among C. glabrata (7.8%), C. krusei (67.9%) and C. rugosa (65.1%). Voriconazole exhibited better activity in vitro than fluconazole, even in isolates fluconazole resistant. The resistance of fluconazole and voriconazole did not increase in the isolates of Candida spp. during the evaluated period.
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França EJGD, Fávero D, Scremin H, Oliveira MTD, Furlaneto-Maia L, Quesada RMB, Furlaneto MC. Hemólise produzida por Candida tropicalis isoladas de amostras clínicas. Rev Soc Bras Med Trop 2010; 43:318-21. [DOI: 10.1590/s0037-86822010000300021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 03/05/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: Leveduras do gênero Candida são responsáveis pela maioria das infecções fúngicas em humanos. Candida tropicalis tem sido uma das mais comumente isoladas dentre as espécies não-albicans. O objetivo foi analisar a hemólise in vitro promovida por isolados clínicos de C. tropicalis provenientes de sangue e outras amostras clínicas de pacientes internados no Hospital Universitário da UEL, PR-Brasil. MÉTODOS: Foi avaliada a hemólise promovida por 28 isolados clínicos de C. tropicalis, sendo os isolados agrupados em classes de acordo com os níveis de hemólise. RESULTADOS: A maioria dos isolados de sangue apresentou hemólise fraca (+), enquanto as classes de hemólise forte (+++) e muito forte (++++) foram as predominantes nos isolados de outras amostras clínicas como urina, lesão de unha e secreção traqueal, embora não tenham sido detectadas diferenças estatísticas (p>0,05). CONCLUSÕES: Isolados de C. tropicalis, obtidos de diferentes amostras clínicas, apresentam capacidade de promover hemólise in vitro.
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Hinrichsen SL, Falcão É, Vilella TAS, Colombo AL, Nucci M, Moura L, Rêgo L, Lira C, Almeida L. Candidemia em hospital terciário do nordeste do Brasil. Rev Soc Bras Med Trop 2008; 41:394-8. [DOI: 10.1590/s0037-86822008000400014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Realizou-se um estudo observacional, prospectivo, de base laboratorial, para investigar a incidência de candidemia, distribuição de espécies e condições clínicas entre setembro 2003 e março 2004, em um hospital privado terciário em Recife, Nordeste do Brasil. Um caso de candidemia foi definido como isolamento de Candida spp de hemocultura. A taxa de incidência foi calculada por 1.000 admissões. Um total de 5.532 pacientes foram admitidos no hospital durante o período de estudo, e 1.745 culturas de sangue foram processadas. Foram observados 21 episódios de candidemia em 18 pacientes. A taxa de incidência de candidemia foi de 3,9 episódios por 1.000 admissões. Espécies não-albicans representaram mais de 50% dos casos, predominando Candida parapsilosis (33%) e Candida tropicalis (24%). Onze (61%) pacientes morreram. A incidência de candidemia foi mais alta que aquela observada em estudo multicêntrico brasileiro. Candidemia foi predominantemente causada por espécies não-albicans.
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