Abstract
Candidemia has been considered a persistent public health problem with great impact on hospital costs and high mortality. We aimed to evaluate the epidemiology and prognostic factors of candidemia in a tertiary hospital in Northeast Brazil from January 2011 to December 2016. Demographic and clinical data of patients were retrospectively obtained from medical records and antifungal susceptibility profiling was performed using the broth microdilution method. A total of 68 episodes of candidemia were evaluated. We found an average incidence of 2.23 episodes /1000 admissions and a 30-day mortality rate of 55.9%. The most prevalent species were Candida albicans (35.3%), Candida tropicalis (27.4%), Candida parapsilosis (21.6%) and Candida glabrata (11.8%). Higher mortality rates were observed in cases of candidemia due to C. albicans (61.1%) and C. glabrata (100%), especially when compared to C. parapsilosis (27.3%). Univariate analysis revealed some variables which significantly increased the probability of death: older age (P = 0.022; odds ratio [OR] = 1.041), severe sepsis (P < 0.001; OR = 8.571), septic shock (P = 0.035; OR = 3.792), hypotension (P = 0.003; OR = 9.120), neutrophilia (P = 0.046; OR = 3.080), thrombocytopenia (P = 0.002; OR = 6.800), mechanical ventilation (P = 0.009; OR = 8.167) and greater number of surgeries (P = 0.037; OR = 1.920). Multivariate analysis showed that older age (P = 0.040; OR = 1.055), severe sepsis (P = 0.009; OR = 9.872) and hypotension (P = 0.031; OR = 21.042) were independently associated with worse prognosis. There was no resistance to amphotericin B, micafungin or itraconazole and a low rate of resistance to fluconazole (5.1%). However, 20.5% of the Candida isolates were susceptible dose-dependent (SDD) to fluconazole and 7.7% to itraconazole. In conclusion, our results could assist in the adoption of strategies to stratify patients at higher risk for developing candidemia and worse prognosis, in addition to improve antifungal management.
Highlights
Candidemia, or the bloodstream infection (BSI) caused by Candida species, is a subset of invasive candidiasis (IC) with increased incidence over the last few decades, considered a persistent public health problem with great impact on health care-associated costs and high crude (35% to 75%) and attributable mortality, despite advances achieved in diagnosis and treatment [1,2,3,4,5,6].Candida species are generally referred as the fourth leading cause of nosocomial BSI in the United States (US), accounting for 8 to 10% of all hospital-acquired BSIs [1,2,3]
Considering the scarcity of Candida BSIs studies conducted in Northeast Brazil (Brazil’s lowest income region) and the relevance of the knowledge of local peculiarities to assist the optimization of strategies for prevention and treatment of infections, we aimed to evaluate the epidemiology of candidemia and risk factors associated with mortality in a tertiary hospital in this Brazilian region over 6 years
The overall incidence rate of candidemia observed in our study (2.23 episodes per 1000 admissions) was close to the findings of Brazilian multicenter studies (2.42 to 2.49/1000 admissions) [24, 25] and those reported in the US (1.9 to 2.4/1000 admissions) [2], but higher than the rates reported in a multicenter study in Latin America (1.18/1000 admissions) [26], in several European countries (0.23 to 1.5/1000 admissions) [27,28,29,30,31,32,33,34] and in a recent study conducted in Japan (0.056/1000 admissions) [35]
Summary
Candida species are generally referred as the fourth leading cause of nosocomial BSI in the United States (US), accounting for 8 to 10% of all hospital-acquired BSIs [1,2,3]. A study encompassing several US states reported Candida spp. as the most prevalent pathogens obtained from nosocomial BSIs, even overcoming some common bacterial species [7]. At least 15 different Candida spp. have been reported to cause human invasive infections. C. albicans remains the most frequently isolated species from Candida BSI episodes, its incidence has recently decreased [2, 3, 8, 10]
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