RESUMEN
OBJECTIVES: To describe all cases of nosocomial candidaemia that occurred in patients in use of anti-fungals. METHODS: Retrospective cohort study (1995-2003). Breakthrough candidaemia was defined as the occurrence of candidaemia in a patient receiving at least 3 days of systemic anti-fungal therapy. Patients with breakthrough candidaemia were compared to patients with non-breakthrough candidaemia. RESULTS: During the period of study, 20 patients had breakthrough candidaemia, and 40% of them had cancer. While most of these episodes occurred with amphotericin B, some patients received low-dose regimens of fluconazole or ketoconazole in association with ranitidine. Non-Candida albicans species caused 75% of these infections, mainly Candida parapsilosis (30%). When compared to controls (n=171), the breakthrough group had more frequently mucositis, longer stay in the intensive care unit, and longer periods of hyperalimentation, mechanical ventilation, urinary catheter and broad-spectrum antibiotics. Candida isolation from sites other than blood occurred more frequently in the breakthrough group. Mortality rate and Candida species distribution were similar among groups. CONCLUSIONS: C. parapsilosis was the main aetiology of breakthrough candidaemia. Common risk factors included mucositis, isolation of Candida from sites other than blood, use of broad-spectrum antibiotics, and invasive medical procedures. No difference in the mortality rate was observed.
Asunto(s)
Antifúngicos/uso terapéutico , Candidiasis/microbiología , Infección Hospitalaria/microbiología , Fungemia/microbiología , Adolescente , Adulto , Anciano , Candida/clasificación , Candida/aislamiento & purificación , Candidiasis/tratamiento farmacológico , Candidiasis/mortalidad , Niño , Preescolar , Estudios de Cohortes , Femenino , Fungemia/tratamiento farmacológico , Fungemia/mortalidad , Humanos , Recién Nacido , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Insuficiencia del TratamientoRESUMEN
Although there are numerous studies of candidaemia in adults, data on paediatrics are still limited. The aim of this study was to compare risk factors, aetiology, therapy, and the outcome of nosocomial candidaemia among paediatric and adult patients in a large Brazilian tertiary hospital (1995-2003). During this period, 78 paediatrics and 113 adults were studied. Species other than Candida albicans caused 78.2% of episodes of candidaemia in paediatrics. Compared to adults, paediatrics received more frequently broad-spectrum antibiotics, vasopressors, blood transfusions, arterial catheter, chest tube, cardiothoracic surgery, mechanical ventilation, and parenteral nutrition. Candidaemia caused by Candida parapsilosis was more common in paediatrics, as was the isolation of Candida spp. from catheters. Amphotericin B treatment was more common in paediatrics. Mortality rate was higher in adults than in paediatrics with nosocomial candidaemia. We reinforce the necessity of continuous epidemiologic surveillance to follow the dynamics of candidaemia.
Asunto(s)
Candida/aislamiento & purificación , Candidiasis/epidemiología , Infección Hospitalaria/epidemiología , Fungemia/epidemiología , Enfermedades del Prematuro/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Candida/clasificación , Candida albicans/aislamiento & purificación , Candidiasis/microbiología , Candidiasis/fisiopatología , Niño , Estudios de Cohortes , Infección Hospitalaria/microbiología , Infección Hospitalaria/fisiopatología , Femenino , Fungemia/microbiología , Fungemia/fisiopatología , Humanos , Lactante , Recién Nacido de Bajo Peso , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/microbiología , Enfermedades del Prematuro/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Candidaemia is perceived as a nosocomial infection. The aim of this study was to describe all cases of candidaemia that occurred in the outpatient setting, and to compare risk factors and outcome among patients with outpatient-acquired and nosocomial candidaemia. During 1995 and 2003, 210 patients developed candidaemia at our institution, and 9.0% were outpatient acquired. Major underlying diseases were cancer (47.4%) and chronic renal failure (36.8%). Most occurred within 24 h of hospitalization (63.2%), and 83.7% were caused by species other than Candida albicans, mainly Candida parapsilosis (36.8%). Candida spp. were isolated from catheters in 21% of cases, and 52.6% of patients had been admitted to hospital in the 60 days preceding candidaemia. Compared with patients with nosocomial candidaemia, chronic renal failure was more frequent in the outpatient group, who were also more commonly exposed to haemodialysis. Ileus, gastrointestinal bleeding, previous bacteraemia, use of proton pump inhibitors, previous stay in the intensive care unit and requirement for antibiotics, blood transfusion, vasopressors and invasive medical procedures were more frequent in the nosocomial group. Overall mortality was high in both groups. Candidaemia must be considered as a potential cause of sepsis in the community, and it is associated with a high mortality rate.