A Prospective, Multi-center Study of Candida Bloodstream Infections in Chile

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2019 Mar 9

PMID 30849092

Citations 21

Authors

Maria E Santolaya

Luis Thompson

Dona Benadof

Cecilia Tapia

Paulette Legarraga

Claudia Cortes

Marcela Rabello

Romina Valenzuela

Pamela Rojas

Ricardo Rabagliati

Affiliations

Soon will be listed here.

Abstract

Background: Active surveillance is necessary for improving the management and outcome of patients with candidemia. The aim of this study was to describe epidemiologic and clinical features of candidemia in children and adults in tertiary level hospitals in Chile.

Methods: We conducted a prospective, multicenter, laboratory-based survey study of candidemia in 26 tertiary care hospitals in Chile, from January 2013 to October 2017.

Results: A total of 780 episodes of candidemia were included, with a median incidence of 0.47/1,000 admissions. Demographic, clinical and microbiological information of 384 cases of candidemia, from 18 hospitals (7,416 beds), was included in this report. One hundred and thirty-four episodes (35%) occurred in pediatric patients and 250 (65%) in adult population. Candida albicans (39%), Candida parapsilosis (30%) and Candida glabrata (10%) were the leading species, with a significant difference in the distribution of species between ages. The use of central venous catheter and antibiotics were the most frequent risk factors in all age groups (> 70%). Three hundred and fifteen strains were studied for antifungal susceptibility; 21 strains (6.6%) were resistant to fluconazole, itraconazole, voriconazole, anidulafungin or micafungin. The most commonly used antifungal therapies were fluconazole (39%) and echinocandins (36%). The overall 30-day survival was 74.2%, significantly higher in infants (82%) and children (86%) compared with neonates (72%), adults (71%) and elderly (70%).

Conclusions: Our prospective, multicenter surveillance study showed a low incidence of candidemia in Chile, with high 30-day survival, a large proportion of elderly patients, C. glabrata as the third most commonly identified strain, a 6.6% resistance to antifungal agents and a frequent use of echinocandins.

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References

Farmakiotis D, Kontoyiannis D . Epidemiology of antifungal resistance in human pathogenic yeasts: current viewpoint and practical recommendations for management. Int J Antimicrob Agents. 2017; 50(3):318-324. DOI: 10.1016/j.ijantimicag.2017.05.019. View

Nucci M, Thompson-Moya L, Guzman-Blanco M, Tiraboschi I, Cortes J, Echevarria J . [Recommendations for the management of candidemia in adults in Latin America. Grupo Proyecto Épico]. Rev Iberoam Micol. 2013; 30(3 Suppl 1):179-88. DOI: 10.1016/j.riam.2013.06.001. View

Hesstvedt L, Arendrup M, Poikonen E, Klingpor L, Friman V, Nordoy I . Differences in epidemiology of candidaemia in the Nordic countries - what is to blame?. Mycoses. 2016; 60(1):11-19. DOI: 10.1111/myc.12535. View

Siri L, Legarraga P, Garcia P, Gonzalez T, Rabagliati R . [Clinical and epidemiological changes of candidemia among adult patients from 2000 to 2013]. Rev Chilena Infectol. 2017; 34(1):19-26. DOI: 10.4067/S0716-10182017000100003. View

Almirante B, Rodriguez D, Park B, Cuenca-Estrella M, Planes A, Almela M . Epidemiology and predictors of mortality in cases of Candida bloodstream infection: results from population-based surveillance, barcelona, Spain, from 2002 to 2003. J Clin Microbiol. 2005; 43(4):1829-35. PMC: 1081396. DOI: 10.1128/JCM.43.4.1829-1835.2005. View

Rodriguez-Hernandez M, Ruiz-Perez De Pipaon M, Marquez-Solero M, Martin-Rico P, Caston-Osorio J, Guerrero-Sanchez F . [Candidemias: multicentre analysis in 16 hospitals in Andalusia (Spain)]. Enferm Infecc Microbiol Clin. 2011; 29(5):328-33. DOI: 10.1016/j.eimc.2010.12.003. View

Horn D, Neofytos D, Anaissie E, Fishman J, Steinbach W, Olyaei A . Epidemiology and outcomes of candidemia in 2019 patients: data from the prospective antifungal therapy alliance registry. Clin Infect Dis. 2009; 48(12):1695-703. DOI: 10.1086/599039. View

Chen S, Slavin M, Nguyen Q, Marriott D, Playford E, Ellis D . Active surveillance for candidemia, Australia. Emerg Infect Dis. 2006; 12(10):1508-16. PMC: 3290948. DOI: 10.3201/eid1210.060389. View

Farmakiotis D, Kontoyiannis D . Emerging issues with diagnosis and management of fungal infections in solid organ transplant recipients. Am J Transplant. 2015; 15(5):1141-7. DOI: 10.1111/ajt.13186. View

10.

Orasch C, Marchetti O, Garbino J, Schrenzel J, Zimmerli S, Muhlethaler K . Candida species distribution and antifungal susceptibility testing according to European Committee on Antimicrobial Susceptibility Testing and new vs. old Clinical and Laboratory Standards Institute clinical breakpoints: a 6-year prospective.... Clin Microbiol Infect. 2013; 20(7):698-705. DOI: 10.1111/1469-0691.12440. View

11.

Delaloye J, Calandra T . Invasive candidiasis as a cause of sepsis in the critically ill patient. Virulence. 2013; 5(1):161-9. PMC: 3916370. DOI: 10.4161/viru.26187. View

12.

Lin S, Chen R, Zhu S, Wang H, Wang L, Zou J . Candidemia in Adults at a Tertiary Hospital in China: Clinical Characteristics, Species Distribution, Resistance, and Outcomes. Mycopathologia. 2018; 183(4):679-689. DOI: 10.1007/s11046-018-0258-5. View

13.

Rodriguez L, Bustamante B, Huaroto L, Agurto C, Illescas R, Ramirez R . A multi-centric Study of Candida bloodstream infection in Lima-Callao, Peru: Species distribution, antifungal resistance and clinical outcomes. PLoS One. 2017; 12(4):e0175172. PMC: 5395148. DOI: 10.1371/journal.pone.0175172. View

14.

Magill S, Edwards J, Bamberg W, Beldavs Z, Dumyati G, Kainer M . Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014; 370(13):1198-208. PMC: 4648343. DOI: 10.1056/NEJMoa1306801. View

15.

Nwankwo L, Periselneris J, Cheong J, Thompson K, Darby P, Leaver N . A Prospective Real-World Study of the Impact of an Antifungal Stewardship Program in a Tertiary Respiratory-Medicine Setting. Antimicrob Agents Chemother. 2018; 62(10). PMC: 6153826. DOI: 10.1128/AAC.00402-18. View

16.

Wu P, Liu W, Hsieh M, Hii I, Lee Y, Lin Y . Epidemiology and antifungal susceptibility of candidemia isolates of non-albicans Candida species from cancer patients. Emerg Microbes Infect. 2017; 6(10):e87. PMC: 5658770. DOI: 10.1038/emi.2017.74. View

17.

Doi A, Pignatari A, Edmond M, Marra A, Camargo L, Siqueira R . Epidemiology and Microbiologic Characterization of Nosocomial Candidemia from a Brazilian National Surveillance Program. PLoS One. 2016; 11(1):e0146909. PMC: 4726651. DOI: 10.1371/journal.pone.0146909. View

18.

Marchetti O, Bille J, Fluckiger U, Eggimann P, Ruef C, Garbino J . Epidemiology of candidemia in Swiss tertiary care hospitals: secular trends, 1991-2000. Clin Infect Dis. 2004; 38(3):311-20. DOI: 10.1086/380637. View

19.

Corzo-Leon D, Alvarado-Matute T, Colombo A, Cornejo-Juarez P, Cortes J, Echevarria J . Surveillance of Candida spp bloodstream infections: epidemiological trends and risk factors of death in two Mexican tertiary care hospitals. PLoS One. 2014; 9(5):e97325. PMC: 4022628. DOI: 10.1371/journal.pone.0097325. View

20.

Bassetti M, Righi E, Ansaldi F, Merelli M, Trucchi C, Cecilia T . A multicenter study of septic shock due to candidemia: outcomes and predictors of mortality. Intensive Care Med. 2014; 40(6):839-45. DOI: 10.1007/s00134-014-3310-z. View