Abstract

BackgroundCandidemia is an increasing problem in tertiary care hospitals worldwide. Here, we report the first outbreak of candidemia caused by fluconazole-resistant C. parapsilosis (FRCP) strains in Brazil.MethodsThis was a cross-sectional study of clinical and microbiological data of all candidemic episodes diagnosed from July 2011 to February 2012 in a 200-bed tertiary care hospital. Initial yeast identification and susceptibility testing were performed using the VITEK 2 - System. Isolates of Candida spp. resistant to fluconazole were sent to a reference laboratory (LEMI-UNIFESP) for further molecular identification and confirmation of resistance by CLSI microdilution test. A multivariate analysis was conducted to identify factors associated with FRCP infection.ResultsWe identified a total of 40 critically ill patients with candidemia (15 women) with a median age of 70 years. The incidence of candidemia was 6 cases/1,000 patients admissions, including 28 cases (70 %) of infection with C. parapsilosis, 21 of which (75 %) were resistant to fluconazole. In only 19 % of FRCP candidemia cases had fluconazole been used previously. The results of our study indicated that diabetes is a risk factor for FRCP candidemia (p = 0.002). Overall, mortality from candidemia was 45 %, and mortality from episodes of FRCP infections was 42.9 %.ConclusionsThe clustering of incident cases in the ICU and molecular typing of strains suggest horizontal transmission of FRCP. Accurate vigilant monitoring for new nosocomial strains of FRCP is required.

Highlights

  • Candidemia is an increasing problem in tertiary care hospitals worldwide

  • The VITEK 2 system identified 28 blood stream Candida isolates as C. parapsilosis (70 %), 9 as C. albicans (22.5 %), 2 as C. glabrata (5 %) and 1 as C. tropicalis (2.5 %)

  • All 9 C. albicans, 2 C. glabrata and 1 C. tropicalis strains were considered susceptible to fluconazole by the automated system

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Summary

Introduction

Candidemia is an increasing problem in tertiary care hospitals worldwide. Here, we report the first outbreak of candidemia caused by fluconazole-resistant C. parapsilosis (FRCP) strains in Brazil. The large variation in the incidence rates of candidemia is probably due to a Candida albicans is still considered the main causative species of candidemia worldwide, there is a concern over the rise in invasive infections caused by non-albicans species. In this regard, Candida glabrata has frequently been reported in Northern Europe and US medical centers [1, 10], whereas Candida parapsilosis and Candida tropicalis are the most common non-

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