Six-Year Trend Analysis of Nosocomial Candidemia and Risk factors in Two Intensive Care Hospitals in Mato Grosso, Midwest Region of Brazil

Abstract

We conducted this cross-sectional retrospective study using clinical and laboratory data from two tertiary hospitals in Cuiabá, Mato Grosso, Brazil, in order to explore the risk factors and estimate mortality, prevalence and lethality of candidemia between 2006 and 2011. A total of 130 episodes of candidemia were identified. The prevalence of candidemia was 1.8 per 1,000 admissions, the mortality rate was 0.9 per 1,000 admissions, and the lethality was 49.2 %. The main agent in this population was Candida parapsilosis (n = 50), followed by C. albicans (n = 45). Comparison between the numbers of episodes in the two triennia revealed that the non-albicans group grew by 48.2 %. The distribution of yeast species of Candida per hospital unit revealed that C. albicans was more prevalent than C. parapsilosis in the adult ICU and C. parapsilosis was more prevalent than C. albicans in the neonatal ICU. Patients remained hospitalized for an average of 53.5 days. Central venous catheters, parenteral nutrition and age were the variables that proved to be independent in the multivariate analysis and that maintained a statistically significant association with the incidence of death in patients with candidemia. The annual prevalence of candidemia showed a significant increase in the second triennium (2009-2011) compared with the first (2006-2008) probably due to increased exposure to risk factors: central venous catheter, H2 blockers, nutrition parenteral corticosteroids and mean hospital duration.

Risk factors for Candida parapsilosis bloodstream infection in a neonatal intensive care unit: a case-control study

“…Several studies analyzed risk factors for neonatal candidiasis without distinguishing among isolated Candida species [7–11], while few studies analyzed risk factors for invasive C. parapsilosis infections in neonates by univariate analysis [13–15] or multivariate analysis [15–17]. Neonatal risk factors for invasive C. parapsilosis infections were birth weight <1500 g, prematurity, prior colonization, parenteral nutrition, intravascular catheters and use of antibiotics, steroids and H2 blockers (13–15).…”

“…When non- albicans Candida species bloodstream infections including those caused by C. parapsilosis were compared with C. albicans bloodstream infections, multivariate logistic regression analysis identified neonatal age, fluconazole exposure and having received an hematological transplant as factors associated with a risk of candidemia caused by non- albicans Candida species [16]. Risk factors analysis of nosocomial candidemia in an adult intensive care unit (ICU) and a NICU in Brazil identified sex and parenteral nutrition as independent risk factors of C. parapsilosis bloodstream infections, which were more frequent in NICU than in adult ICU [17]. In agreement with these findings, we identified low birth weight and gestational age (explaining more than 55.0% of the variance) as risk factors for C. parapsilosis bloodstream infection in neonates in the NICU.…”

“…are among the most frequent pathogens responsible for HAIs in NICUs, followed by gram positive or gram negative bacteria according to different clinical setting [1–9]. Although Candida albicans remains the most frequently isolated in many centers [9, 10], Candida parapsilosis has emerged as the most frequent non-albicans Candida species and the predominant pathogen of invasive candidiasis in neonates [8, 11–17]. In the tertiary care NICU of University Hospital in Naples, Italy, C. parapsilosis was the most frequent pathogen responsible for device-associated bloodstream infections (BSI) during 2006–2010 [6].…”

<p>Emerging Invasive Fungal Infections: Clinical Features and Controversies in Diagnosis and Treatment Processes</p>

“…1 The incidence of fungal infection has shown an upward trend. [2][3][4][5] Although significant improvements have been made in disease management and treatment of fungal infections, the mortality rate has only increased. 6 Early diagnosis of invasive fungal infection (IFI) is a difficult in routine clinical practice but key for the initiation of targeted therapies.…”

Epidemiology and clinical presentation of neonatal fungal sepsis in intensive care units of Pediatric clinic Tuzla

“…Therefore, the recommended prophylactic administration of Fluconazole is questionable, and its routine, empirical administration as the first-line therapy may be inappropriate [2]. It is very important to have current information on neonatal fungal isolates and their patterns of antimicrobial susceptibility, and thus be guided in the choice of empirical antifungal therapy [10][11][12][13][14].…”