Surveillance of Candida spp Bloodstream Infections: Epidemiological Trends and Risk Factors of Death in Two Mexican Tertiary Care Hospitals
Date
2014
Type:
Artículo
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6
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ORCID:
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS
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Abstract
Introduction: Larger populations at risk, broader use of antibiotics and longer hospital stays have impacted on the
incidence of Candida sp. bloodstream infections (CBSI).
Objective: To determine clinical and epidemiologic characteristics of patients with CBSI in two tertiary care reference
medical institutions in Mexico City.
Design: Prospective and observational laboratory-based surveillance study conducted from 07/2008 to 06/2010.
Methods: All patients with CBSI were included. Identification and antifungal susceptibility were performed using CLSI M27-
A3 standard procedures. Frequencies, Mann-Whitney U test or T test were used as needed. Risk factors were determined
with multivariable analysis and binary logistic regression analysis.
Results: CBSI represented 3.8% of nosocomial bloodstream infections. Cumulative incidence was 2.8 per 1000 discharges
(incidence rate: 0.38 per 1000 patient-days). C. albicans was the predominant species (46%), followed by C. tropicalis (26%).
C. glabrata was isolated from patients with diabetes (50%), and elderly patients. Sixty-four patients (86%) received
antifungals. Amphotericin-B deoxycholate (AmBD) was the most commonly used agent (66%). Overall mortality rate
reached 46%, and risk factors for death were APACHE II score $16 (OR = 6.94, CI95% = 2.34–20.58, p,0.0001), and liver
disease (OR = 186.11, CI95% = 7.61–4550.20, p = 0.001). Full susceptibility to fluconazole, AmBD and echinocandins among C.
albicans, C. tropicalis, and C. parapsilosis was observed.
Conclusions: The cumulative incidence rate in these centers was higher than other reports from tertiary care hospitals from
Latin America. Knowledge of local epidemiologic patterns permits the design of more specific strategies for prevention and
preemptive therapy of CBSI.
Description
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Citation
May 2014, Volume 9, Issue 5, e97325
Keywords
antifungals, Candida Albicans, Death rates, Candida, Amphotericin, Bloodstream infections, Liver diseases, Nosocomial infections