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.
Highlights
Bloodstream infections (BSI) caused by Candida species are an important cause of morbidity and mortality in hospitalised patients worldwide (Zaoutis et al 2005, Odds et al 2007, Pfaller & Diekema 2007, Hsueh & Ruan 2009)
We found an incidence rate of 1.20 infections per 1,000 hospital admissions
This is similar to the incidence rates published by other groups in our country (Colombo et al 2007, França et al 2008, Girão et al 2008, Nucci et al 2010), but consistently higher than studies conducted in the northern hemisphere
Summary
We detected a total of 388 episodes of candidaemia during the surveillance period. Of these, 60.3% of the patients were males and the mean and median age was 32.4 and 30 years, respectively (range 0-99 years). The overall incidence rate was 1.20 episodes per 1,000 admissions and 0.20 episodes per 1,000 patient-days. There was a significant increase in the incidence of candidaemia per 1,000 patient-days in P2 compared with P1 (0.25 vs 0.15, p = 0.04). The mean age of the patients with candidaemia was 27.2 years and 36.3 years for P1 and P2, respectively. We noted that a significant number of candidaemic patients in both study periods were not treated: 31% (52/165 cases) vs 30% (66/223 cases), respectively (p = 0.68).
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