Prospective observational study of candidemia in Sao Paulo, Brazil: Incidence rate, epidemiology, and predictors of mortality

被引:124
作者
Colombo, Arnaldo L.
Guimaraes, Thais
Silva, Ligia R. B. F.
Monfardini, Leila Paula de Almeida
Cunha, Anna Karenine B.
Rady, Patricia
Alves, Thelma
Rosas, Robert C.
机构
[1] Univ Fed Sao Paulo, Div Infect Dis, Sao Paulo, Brazil
[2] Hosp Serv Publ Estadual, Sao Paulo, Brazil
[3] Hosp Beneficencia Portuguesa, Sao Paulo, Brazil
[4] Casa Saude Santa Marcelina, Sao Paulo, Brazil
关键词
D O I
10.1086/513615
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background. Studies conducted in tertiary care hospitals of different European countries and the United States have shown incidence rates of candidemia ranging from 0.17 to 0.76 and 0.28 to 0.96 per 1,000 admissions, respectively. So far, only 1 study has evaluated the incidence rates of candidemia in tertiary care hospitals in Latin American countries. Objective. To evaluate the epidemiology of candidemia in 4 tertiary care hospitals in Sao Paulo, Brazil. Design. Multicenter, laboratory-based surveillance of candidemia. Results. A total of 7,038 episodes of bloodstream infection were identified, and Candida species accounted for 282 cases (4%). The incidence rate of candidemia was 1.66 candidemic episodes per 1,000 hospital admissions. Candida albicans was the most frequently isolated Candida species in all hospitals, but Candida species other than C. albicans accounted for 62% of isolates, including predominantly Candida parapsilosis and Candida tropicalis. Azole resistance was restricted to only 2% of all Candida isolates ( 1 isolate of Candida glabrata and 4 isolates of Candida rugosa). Candidemia was mostly documented in surgical patients with long durations of hospital stay. The crude mortality rate was 61%, and advanced age and high Acute Physiology and Chronic Health Evaluation II score were both conditions independently associated with risk of death. Conclusions. We observed in our series a higher incidence rate of candidemia than that reported in European countries and the United States. Advanced age and a high Acute Physiology and Chronic Health Evaluation II score were factors associated with a higher probability of death in candidemic patients. Fluconazole-resistant Candida strains are still a rare finding in our case-based study of candidemia.
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页码:570 / 576
页数:7
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