RESUMO
BACKGROUND: The incidence of candidemia in our hospital has been stable over an 18-year period (1.3 episodes per 1000 admissions). Since March 2020, we have observed an increase in cases of candidemia. METHODS: In March 2020, the hospital was prepared to receive patients with COVID-19, with cancellation of elective procedures, discharge of less sick patients and the activation of beds for COVID-19. We compared the incidence of candidemia in 2 periods: from January 2019 to February 2020 (period 1) and from March to September 2020 (period 2). RESULTS: We diagnosed 41 episodes of candidemia, 16 in period 1 and 25 in period 2 (9 COVID-19 patients). Compared with non-COVID-19 patients, COVID-19 patients with candidemia were more likely to be under mechanical ventilation (100% vs. 34.4%, P < .001). The median number of monthly admissions in period 1 and 2 was 723 (interquartile range 655-836) and 523 (interquartile range 389-574), respectively. The incidence of candidemia (per 1000 admissions) was 1.54 in period 1 and 7.44 in period 2 (P < .001). In period 2, the incidence of candidemia (per 1000 admissions) was 4.76 if we consider only cases of candidemia in non-COVID-19 patients, 2.68 if we consider only cases of candidemia in COVID-19 patients and 14.80 considering only admissions of patients with COVID-19. CONCLUSIONS: The increase in the incidence of candidemia in our hospital may be attributed to 2 factors: a reduction in the number of admissions (denominator) and the occurrence of candidemia in COVID-19 patients.
Assuntos
COVID-19/complicações , Candidemia/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , COVID-19/epidemiologia , COVID-19/virologia , Candida/genética , Candida/isolamento & purificação , Candida/fisiologia , Candidemia/epidemiologia , Candidemia/microbiologia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2/fisiologia , Centros de Atenção Terciária/estatística & dados numéricos , Adulto JovemRESUMO
OBJECTIVE: To identify the main risk factors associated with neonatal candidemia. PATIENTS AND METHOD: A retrospective paired case-control study was conducted from January 2014 to December 2016. The cases were patients with isolation in blood culture and/or cerebrospinal fluid of Candi da spp. after their first 48 hours in the hospital and the controls cases were neonates chosen from the statistical census of neonatology paired according to their admission date (30-day range), birth weight, gestational age, and discharge condition (alive or deceased). For each case, we select two controls. The risk factors evaluated were intrahospital stay over seven days, use of broad-spectrum antibiotics, mechanical ventilation, parenteral nutrition longer than five days, invasive procedures such as central venous access and abdominal and thoracic surgeries, necrotizing enterocolitis and growth of bacterial microorganisms in blood culture before candidemia. RESULTS: During the study period, 141 patients developed candidemia. 49% of the cases corresponded to Candida parapsilosis with the highest associated lethality rate. The multivariate analysis identified as risk factors hospital stay longer than seven days (OR = 17.0, 95% CI = 2.36-122.4), use of umbilical lines (OR = 9.04, 95% CI = 1.55-52.5), abdominal and/or thoracic surgery (OR = 12.4, 95% CI = 1.76-87.3), and treatment with Meropenem (OR = 4.62, 95% CI = 1.34-15.9). CONCLUSION: Prolonged intrahospital stay longer than seven days and thoracic and/or abdominal surgery were the most significant risk factors in this study for the development of neonatal candidemia.
Assuntos
Candidemia/etiologia , Candidemia/diagnóstico , Candidemia/mortalidade , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Modelos Logísticos , Masculino , Razão de Chances , Panamá/epidemiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJETIVO: Determinar los principales factores de riesgo asociados a candidemia en neonatos. PACIENTES Y MÉTODO: Se realizó un estudio de casos y controles retrospectivo pareado, desde enero de 2014 a diciembre de 2016. Los casos fueron pacientes con aislamiento en hemocultivo y/o líquido cefalorraquídeo de Candida spp. luego de sus primeras 48 horas intrahospitalarias y los controles fueron neonatos escogidos del censo estadístico de la sala de neonatología pareados según su fecha de admisión a sala (rango de 30 días), peso al nacer, edad gestacional y condición de egreso (vivo o fallecido). Por cada caso seleccionamos dos controles. Los factores de riesgo evaluados fueron la estancia intrahospitalaria mayor a 7 días, el uso de antibióticos de amplio espectro, ventilación mecánica, nutrición parenteral mayor a 5 días, procedimientos invasivos como colocación de accesos venosos centrales y cirugías abdominales y torácicas, enterocolitis necrosante y crecimiento de microorganismo bacteriano en hemocultivo previo a la candidemia. RESULTADOS: Durante el período de estudio hubo aislamiento de Candida spp. en 141 neonatos. Se encontró que el 49% fue de Candida parapsilosis con la mayor letalidad asociada. En el análisis multivariado se identificaron como factores de riesgo la estancia intrahospitalaria mayor a 7 días (OR = 17,0, 95% IC = 2,36-122,4), uso de líneas umbilicales (OR = 9,04, 95% IC = 1,55-52,5), exposición a cirugía (OR = 12,4, 95% IC = 1,76-87,3) y el uso de meropenem (OR = 4,62, 95% IC = 1,34-15,9). CONCLUSIÓN: La estancia intrahospitalaria prolongada mayor a 7 días y la exposición a cirugía fueron los factores de riesgo más importantes en este estudio para el desarrollo de candidemia neonatal.
OBJECTIVE: To identify the main risk factors associated with neonatal candidemia. PATIENTS AND METHOD: A retrospective paired case-control study was conducted from January 2014 to December 2016. The cases were patients with isolation in blood culture and/or cerebrospinal fluid of Candida spp. after their first 48 hours in the hospital and the controls cases were neonates chosen from the statistical census of neonatology paired according to their admission date (30-day range), birth weight, gestational age, and discharge condition (alive or deceased). For each case, we select two controls. The risk factors evaluated were intrahospital stay over seven days, use of broad-spectrum antibiotics, mechanical ventilation, parenteral nutrition longer than five days, invasive procedures such as central venous access and abdominal and thoracic surgeries, necrotizing enterocolitis and growth of bacterial microorganisms in blood culture before candidemia. RESULTS: During the study period, 141 patients developed candidemia. 49% of the cases corresponded to Candida parapsilosis with the highest associated lethality rate. The multivariate analysis identified as risk factors hospital stay longer than seven days (OR = 17.0, 95% CI = 2.36-122.4), use of umbilical lines (OR = 9.04, 95% CI = 1.55-52.5), abdominal and/or thoracic surgery (OR = 12.4, 95% CI = 1.76-87.3), and treatment with Meropenem (OR = 4.62, 95% CI = 1.34-15.9). CONCLUSION: Prolonged intrahospital stay longer than seven days and thoracic and/or abdominal surgery were the most significant risk factors in this study for the development of neonatal candidemia.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Candidemia/etiologia , Panamá/epidemiologia , Unidades de Terapia Intensiva Neonatal , Estudos de Casos e Controles , Modelos Logísticos , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Candidemia/diagnóstico , Candidemia/mortalidadeRESUMO
La Candida haemulonii forma parte de la especie Candida no albicans. La candidemia por C. haemulonii es sumamente infrecuente, pero mortal, en los recién nacidos. Se informa sobre los dos primeros recién nacidos con candidemia por C. haemulonii en China tratados con fluconazol y se revisan dos artículos informados con anterioridad. Nuestro informe incrementa la sensibilización sobre la candidemia por C. haemulonii en recién nacidos críticos y resalta la importancia de un diagnóstico y un tratamiento tempranos de esta infección mortal.
Candida haemulonii forms part of the non-albicans Candida species. The candidemia caused by C. haemulonii is extremely rare but fatal in neonates. We reported the first two neonates with C. haemulonii candidemia in China which were treated with fluconazole and reviewed two papers previously reported. Our report adds further awareness on C. haemulonii candidemia in critical neonates and points out the importance of an early diagnosis and treatment of this fatal infection.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Fluconazol/uso terapêutico , Infecções Relacionadas a Cateter/tratamento farmacológico , Candidemia/tratamento farmacológico , Candida/isolamento & purificação , China , Resultado do Tratamento , Infecções Relacionadas a Cateter/microbiologia , Candidemia/etiologia , Candidemia/microbiologia , Antifúngicos/uso terapêuticoRESUMO
Candida haemulonii forms part of the non-albicans Candida species. The candidemia caused by C. haemulonii is extremely rare but fatal in neonates. We reported the first two neonates with C. haemulonii candidemia in China which were treated with fluconazole and reviewed two papers previously reported. Our report adds further awareness on C. haemulonii candidemia in critical neonates and points out the importance of an early diagnosis and treatment of this fatal infection.
La Candida haemulonii forma parte de la especie Candida no albicans. La candidemia por C. haemulonii es sumamente infrecuente, pero mortal, en los recién nacidos. Se informa sobre los dos primeros recién nacidos con candidemia por C. haemulonii en China tratados con fluconazol y se revisan dos artículos informados con anterioridad. Nuestro informe incrementa la sensibilización sobre la candidemia por C. haemulonii en recién nacidos críticos y resalta la importancia de un diagnóstico y un tratamiento tempranos de esta infección mortal.
Assuntos
Antifúngicos/uso terapêutico , Candidemia/tratamento farmacológico , Infecções Relacionadas a Cateter/tratamento farmacológico , Fluconazol/uso terapêutico , Candida/isolamento & purificação , Candidemia/etiologia , Candidemia/microbiologia , Infecções Relacionadas a Cateter/microbiologia , China , Humanos , Recém-Nascido , Masculino , Resultado do TratamentoRESUMO
La candidiasis es la causa más común de endoftalmitis endógena. La afectación ocular se produce entre los 3 y los 15 días siguientes a la fungemia. Las dos formas características de presentación son la coriorretinitis candidiásica, que afecta a la coroides y a la retina sin afectar claramente al vítreo, y la endoftalmitis candidiásica, con presencia de lesiones vítreas redondeadas, de aspecto algodonoso (perlas vítreas), características de esta infección. Los síntomas visuales precoces más habituales son la visión borrosa y los flotadores. Se recomienda entonces realizar fondo de ojo en las 2 primeras semanas del diagnóstico de candidemia para prevenir complicaciones oculares y usar la afectación ocular como indicador de probable infección fúngica invasiva. La anfotericina B, el fluconazol, el voriconazol, el posaconazol y el ravuconazol, así como las equinocandinas entre las que se encuentran la caspofungina han demostrado su utilidad en el tratamiento de la coriorretinitis, pero la efectividad disminuye en los casos de afectación vítrea si no se asocian a vitrectomía(AU)
Candidiasis is the most common cause of endogenous endophthalmitis. Ocular damage occurs within 3 and 15 days after fungemia. The two characteristic forms of presentation are Candida chorioretinitis, affecting the choroid and the retina with no clear impact on the vitreous, and Candida endophthalmitis, with the presence of rounded cottony vitreous lesions (vitreous pearls), characteristic of this infection. The most common early visual symptoms are blurred vision and floaters. It is thus recommended to perform funduscopy within the first two weeks after the candidemia diagnosis to prevent ocular complications and use the ocular damage as an indicator of probable invasive fungal infection. Amphotericin B, fluconazole, voriconazole, posaconazole and ravuconazole, as well as echinocandins, among them caspofungin, have proven useful in the treatment of chorioretinitis, but effectiveness is lower in vitreous damage cases when they are not associated to vitrectomy(AU)
Assuntos
Humanos , Vitrectomia/métodos , Candidíase/diagnóstico , Coriorretinite/tratamento farmacológico , Endoftalmite/etiologia , Fatores de Risco , Candidemia/etiologia , Fundo de OlhoRESUMO
BACKGROUND: Hemodialysis has been described as an important risk factor for the development of candidemia in patients suffering from chronic renal failure. AIMS: The aim of this study was to evaluate the epidemiology of candidemia in outpatients with renal replacement therapy (RRT) by hemodialysis where the fungemia clearly represents a healthcare-associated infection. METHODS: We retrospectively collected clinical and laboratory data from patients undergoing at least 3 months of RRT by hemodialysis who developed candidemia within 48h of hospital admission. RESULTS: We identified 14 patients with candidemia with central venous catheters (CVC) in place for 11-277 days before developing fungemia. Deep-seated infection was documented in 6 out of 14 candidiasis cases (43%), including 5 cases of endocarditis (36%). CONCLUSIONS: CVC in patients under RRT should be promptly replaced by fistulas and grafts to avoid bloodstream infections. Facing a case of candidemia, adequate source control and prompt initiation of antifungal therapy are mandatory to avoid morbidity and mortality.
Assuntos
Candidíase Invasiva/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Infecção Hospitalar/epidemiologia , Diálise Renal/efeitos adversos , Adulto , Idoso , Brasil/epidemiologia , Candidemia/epidemiologia , Candidemia/etiologia , Candidemia/microbiologia , Candidíase Invasiva/etiologia , Candidíase Invasiva/microbiologia , Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/microbiologia , Cateteres Venosos Centrais/efeitos adversos , Cateteres Venosos Centrais/microbiologia , Infecção Hospitalar/etiologia , Infecção Hospitalar/microbiologia , Suscetibilidade a Doenças , Endocardite/epidemiologia , Endocardite/etiologia , Endocardite/microbiologia , Endoftalmite/epidemiologia , Endoftalmite/etiologia , Endoftalmite/microbiologia , Infecções Oculares Fúngicas/epidemiologia , Infecções Oculares Fúngicas/etiologia , Infecções Oculares Fúngicas/microbiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Diálise Renal/métodos , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemRESUMO
OBJECTIVES: Due to the increase in isolation of Candida spp. in critically ill patients, and the high mortality and economic costs which this infection entails, a study was made of the risk factors associated to candidemia in critically ill patients from 7 intensive care units in Colombia. MATERIALS AND METHODS: A multicenter matched case-control study was conducted in 7 intensive care units of 3 university hospitals. Data on overall length of hospital stay (including both general wards and the intensive care unit) were recorded. RESULTS: A total of 243 subjects (81 cases and 162 controls) between January 2008 and December 2012 were included. In order of frequency, C. albicans, C. tropicalis and C. parapsilosis were isolated. The main identified risk factors were: overall length of hospital stay>25 days (OR 5.33, 95% CI 2.6-10.9), use of meropenem (OR 3.75, 95% CI 1.86-7.5), abdominal surgery (OR 2.9, 95% CI 1.39-6.06) and hemodialysis (OR 3.35, 95% CI 1.5-7.7). No differences in mortality between patients with candidemia and controls were found (39.5 vs. 36.5%, respectively, P=.66) were found. CONCLUSIONS: In Colombia, a long hospital stay, abdominal surgery, the use of meropenem and hemodialysis were identified as risk factors for candidemia.
Assuntos
Candidemia/etiologia , Candidíase/etiologia , Estado Terminal , Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Estudos de Casos e Controles , Colômbia , Infecção Hospitalar , Humanos , Incidência , Tempo de Internação , Fatores de RiscoRESUMO
A distribuição das espécies causadoras de candidemia varia conformeo tipo de hospital, região geográfica, fator de risco e idade dos pacientes,além da política de uso de antifúngicos da unidade hospitalar. Na região daBaixada Santista, estado de São Paulo, há carência desses dados, comvistas à vigilância epidemiológica. Os objetivos deste estudo foram: i)identificar, fenotipicamente, agentes etiológicos de candidemia quanto aogênero e espécie; ii) diferenciar, por técnicas moleculares, isolados de C.albicans e C. dubliniensis, bem como, as novas espécies do complexo C.parapsilosis, (C. orthopsilosis e C. metapsilosis); iii) investigar espéciesemergentes de leveduras como agentes de candidemia; iv) verificar aocorrência de fenótipos de resistência a fluconazol, itraconazol ecaspofungina por método de microdiluição. O estudo envolveu 97 isolados provenientes de hemoculturas obtidos de pacientes com quadro clínicoindicativo de fungemia, atendidos no período de Jan/2008 a Dez/2010 emum hospital público. O perfil de suscetibilidade a antifúngicos (fluconazol, itraconazol e caspofungina) foi avaliado por microdiluição, segundometodologia européia (AFST- EUCAST). A diferenciação das espécies docomplexo C. parapsilosis foi feita por PCR-RFLP. Para identificaçãogenotípica de C. albicans e C. dubliniensis foi realizado PCR, com doisprimers (CAL5/NL4CAL e CDU2/NL4CAL), indicando ausência de C. dubliniensis. Entre os agentes de candidemia encontramos: C. parapsilosis (45; 46,4%), C. albicans (34; 35,1%), C. tropicalis (15; 15,5%), C. guilliermondii (2; 2,1%) e C. glabrata (1; 1%). Um número significativo de casos de candidemia (50; 51,5%) foi representada por pacientes recémnascidose os agentes foram: C. parapsilosis (29, 58%), C. albicans (18,36%), C. tropicalis (2; 4%), e C. guilliermondii (1, 2%). Nós relatamos uma distribuição de espécies incomuns como C. parapsilosis superior a C...