Factors associated with candidemia by non-albicans Candida group in midwest region of Brazil: Eight-year cross-sectional study

Abstract

The alarming increase in the non-albicans Candida group (NAC) as the etiologic agent of bloodstream infections has made it necessary for the factors associated with candidemia caused by NAC to be elucidated. A cross-sectional retrospective study was conducted which included analysis of microbiological reports, medical records and hospital infection notifications in two tertiary hospitals (Mato Grosso, Brazil) over 8 years (2006 to 2014). Of 144 observed episodes of candidemia, the NAC group represented 64.6%. The prevalence of candidemia caused by NAC was equal to 1.10 × 1,000 admissions, which was statistically different (p<0.001) from and greater than the prevalence of Candida albicans (CA). Hospitalization in the intensive care unit (PR = 1.83; p = 0.05), length of stay ≥42 days (PR = 0.62; p = 0.01) and the use of H2 blockers (PR = 1.75; p = 0.03) were significantly associated with death in patients with candidemia caused by NAC, regardless of gender, use of central venous catheter, treatment with amphotericin B and mechanical ventilation. The incidence of candidemia caused by NAC was 34% higher in men and 40% higher in patients who remained hospitalized for ≥42 days, regardless of prematurity, neutropenia, catheter, mechanical ventilation and age. After 42 days of hospitalization, the chances of survival were 67.3% among patients with candidemia caused by NAC and 56.4% among patients with candidemia caused by CA. This study suggests a different behavior between CA and NAC groups, which should be especially considered for choice of treatment regimen with antifungals. Key words: Candidemia, nosocomial bloodstream infection, epidemiology, tertiary care centers.