de la Torre-Saldaña VA, Martínez-Velázquez M, Reséndiz-Sánchez J

Idioma: Español
Referencias bibliográficas: 55
Paginas: 121-132
Archivo PDF: 677.99 Kb.

RESUMEN

Antecedentes: la incidencia de las infecciones fúngicas severas ha aumentado, por ello es importante identificar los factores predisponentes y definir con criterios clínicos el inicio temprano de un tratamiento antimicótico.
Objetivo: determinar los factores de riesgo de candidemia en pacientes adultos, la susceptibilidad a fármacos y la especie de Candida sp en pacientes atendidos en el Hospital Juárez de México.
Material y método: estudio retrospectivo y descriptivo efectuado de agosto de 2012 a julio de 2013 con pacientes con candidemia. Los datos se obtuvieron del expediente clínico y del laboratorio de microbiología; siete cepas se enviaron al Laboratorio de Micología del Hospital Infantil de México Federico Gómez para determinar la susceptibilidad a antimicóticos e identificar la especie de Candida sp.
Resultados: se reportaron 18 casos de candidemia, en 7 se determinó la especie de Candida sp, la principal fue Candida albicans; la Unidad de Cuidados Intensivos fue el servicio con más casos. El 94.4% de los pacientes tuvo tres puntos o más del puntaje de Candida; los principales factores de riesgo de candidemia fueron: nutrición parenteral total, sepsis grave, catéteres venosos centrales y exposición a múltiples antibióticos de amplio espectro. Tres cepas tuvieron resistencia a azoles.
Conclusiones: los enfermos críticos tienen mayor predisposición a candidemia; tener sepsis severa, recibir antibióticos de amplio espectro, nutrición parenteral total y usar dispositivos invasivos son los principales factores de riesgo. En las cepas de Candida de nuestra población se observó resistencia a azoles, por lo que es importante determinar rutinariamente la susceptibilidad a los fármacos para proporcionar profilaxis y tratamiento efectivos.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Pappas PG. Invasive candidiasis. Infect Dis Clin North Am 2006;20:485-506.

2. Glick M, Siegel MA. Viral and fungal infections of the oral cavity in immunocompetent patients. Infect Dis Clin North Am 1999;13:817-831.

3. Pfaller MA, Messer SA, Moet GJ, Jones RN, Castanheria M. Candida bloodstream infections: comparison of species distribution and resistance to echinocandin and azole antifungal agents in Intensive Care Unit (ICU) and non-ICU settings in the SENTRY Antimicrobial Surveillance Program (2008-2009). International Journal of Antimicrobial Agents 2011;38:65-69.

4. Rentz AM, Halpern MT, Bowden R. The impact of candidemia on length of hospital stay, outcome, and overall cost of illness. Clin Infect Dis 1998;27:781-788.

5. Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microbiol Rev 2007;20:133-163.

6. Nucci M, et al. Epidemiology of candidemia in Latin America: A laboratory-based survey. PLoS ONE 2013;8:3.

7. Lepak A, Andes D. Fungal Sepsis: Optimizing antifungal therapy in the critical care setting. Crit Care Clin 2011;27:123-147.

8. Mandell GL, Bennett JE, Dolin R. Enfermedades infecciosas. Principios y práctica. 7a ed. Editorial Elsevier, 2011;4155.

9. Sendid B, Tabouret M, Poirot JL, et al. New enzyme immunoassays for sensitive detection of circulating Candida albicans mannan and antimannan antibodies: useful combined test for diagnosis of systemic candidiasis. J Clin Microbiol 1999;37:1510-1517.

10. Pfaller MA, Diekma DJ, Gibbs DL, Newell VA, et al. Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2005: an 8.5 year analysis of susceptibilities of Candida species an other yeast species to fluconazole and voriconazole determined by CLSI standardized disk diffusion testing. J Clin Microbiol 2007:1735-1745.

11. Sánchez G y col. Epidemiología de las infecciones sistémicas por Candida en el Hospital de Pediatría del Centro Médico Nacional Siglo XXI. Bol Med Hosp Infant Mex 2004;61:289-296.

12. Reséndiz SJ, Morales AJJ. Factores asociados a mortalidad por fungemias causadas por Candida sp. en niños. Bol Med Hosp Infant Mex 2007;64:91-98.

13. Cuenca-Estrella M, Rodríguez-Tudela JL. The current role of the reference procedures by CLSI and EUCAST in the detection of resistance to antifungal agents in vitro. Expert Rev Anti Infect Ther 2010;8:267-276.

14. Zarate V y col. Prevalencia, factores de riesgo y mortalidad de los pacientes con candidemia atendidos en el Hospital San Juan de Dios durante enero 2008 a diciembre 2010. Rev Cl EMed UCR 2012;2.

15. Blot SI, Vandewoude KH, Hoste EA, Colardyn FA. Effects of nosocomial candidemia on outcomes of critically ill patients. Am J Med 2002;113:480-485.

16. Pappas PG, Rex JH, Sobel JD, Filler SG, et al. Guidelines for treatment of candidiasis. Clin Infect Dis 2004;38:161-189.

17. Horn DL, Neofytos D, Anaissie EJ, et al. Epidemiology and outcomes of candidemia in 2019 patients: data from the prospective antifungal therapy alliance registry. Clin Infect Dis 2009;48:1695-1703.

18. Kontoyiannis DP, Vaziri I, Hanna HA, et al. Risk factors for Candida tropicalis fungemia in patients with cancer. Clin Infect Dis 2001;33:1676-1681.

19. León C, Ruiz-Santana S, Saavedra P, Almirante B, et al. A bedside scoring system (“Candida score”) for early antifungal treatment in non-neutropenic critically ill patients with Candida colonization. Crit Care Med 2006;34:730-737.

20. Rodríguez-Hernández MJ, Ruiz-Pérez de Pipaon M, Márquez M, Martín-Rico P, et al. Candidemias: análisis multicéntrico en 16 hospitales andaluces. Enf Infecc Microbiol Clin 2011;29:328-333.

21. Rex JH, Bennett JE, Sugar AM, Pappas PG, Van der Horst CM, Edwards JE, et al. A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia. Candidemia Study Group and the National Institute. N Engl J Med 1994;331:1325-1330.

22. Segal BH, Kwon-Chung J, Walsh TJ, Klein BS, et al. Immunotherapy for fungal infections. Clin Infect Dis 2006;42:507-515.

23. Garey KW, Rege M, Pai MP, et al. Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study. Clin Infect Dis 2006;43:25-31.

24. Ostrosky-Zeichner L, Pappas PG. Invasive candidiasis in the intensive care unit. Crit Care Med 2006;34:857-863.

25. Diekema DJ, Pfaller MA. Nosocomial candidemia: an ounce of prevention is better than a pound of cure. Infect Control Hosp Epidemiol 2004;25:624-626.

26. Munoz P, Burillo A, Bouza E. Criteria used when initiating antifungal therapy against Candida spp. in the intensive care unit. Int J Antimicrob Agents 200;15:83-90.

27. Ostrosky-Zeichner L. New approaches to the risk of Candida in the intensive care unit. Curr Opin Infect Dis 2003;16:533-537.

28. Ostrosky-Zeichner L. Prophylaxis and treatment of invasive candidiasis in the intensive care setting. Eur J Clin Microbiol Infect Dis 2004;23:739-744.

29. Pfaller MA, Pappas PG, Wingard JR. Invasive fungal pathogens: current epidemiological trends. Clin Infect Dis 2006;43:3-14.

30. Prentice HG, Kibbler CC, Prentice AG. Towards a targeted, risk-based, antifungal strategy in neutropenic patients. Br J Haematol 2000;110:273-284.

31. Puzniak L, Teutsch S, Powderly W, Polish L. Has the epidemiology of nosocomial candidemia changed? Infect Control Hosp Epidemiol 2004;25:628-633.

32. Wey SB, Mori M, Pfaller MA, Woolson RF, Wenzel RP. Hospital-acquired candidemia: the attributable mortality and excess length of stay. Arch Intern Med 1988;148:2642- 2645.

33. Ben-Ami R, Weinberger M, Orni-Wasserlauff R, et al. Time to blood culture positivity as a marker for catheter related candidemia. J Clin Microbiol 2008;46:2222-2226.

34. Bross J, Talbot GH, Maislin G, Hurwits S, et al. Risk factors for nosocomial candidemia: a case control study in adults without leukemia. Am J Med 1989;87:614-620.

35. Wey SB, Mori M, Pfaller MA, Woolson RF, et al. Risk factors for hospital-acquired candidemia. A matched case-control study. Arch Intern Med 1989;149:2349-2353.

36. Karabinis A, Hill C, Leclercq B, Tancrede C, et al. Risk factors for candidemia in cancer patients: a case-control study. J Clin Microbiol 1988;26:429-432.

37. Eggimann P, Garbino J, Pittet D. Management of Candida species infections in critically ill patients. Lancet Infect Dis 2003;3:772-785.

38. Lipsett PA. Surgical critical care: fungal infections in surgical patients. Crit Care Med 2006;34:215-224.

39. Nucci M, Marr KA. Emerging fungal diseases. Clin Infect Dis 2005;41:521-526.

40. Pfaller MA, Diekema DJ. Rare and emerging opportunistic fungal pathogens: concern for resistance beyond Candida albicans and Aspergillus fumigatus. J Clin Microbiol 2004;42:4419-4431.

41. Rodríguez-Hernández MJ, Ruiz-Pérez de Pipaon M, Márquez M, Martín-Rico P, et al. Candidemias: análisis multicéntrico en 16 hospitales andaluces. Enf Infecc Microbiol Clin 2011;29:328-333.

42. Gullu AU et al. Case report-valves candida parapsilosis tricuspid native valve endocarditis: 3-year follow-up after surgical treatment. Interactive CardioVascular and Thoracic Surgery 2008;7:513-514.

43. Garzoni C, Nobre VA, Garbino J. Candida parapsilosis endocarditis: a comparative review of the literature. Eur J Clin Microbiol Infect Dis 2007;26:915-926.

44. Rajendram R, Alp NJ, Mitchell AR, Bowler IC, Forfar JC. Candida prosthetic valve endocarditis cured by caspofungin therapy without valve replacement. Clin Infect Dis 2005;40:72-74.

45. Lye DC, Hughes A, O'Brien D, Athan E. Candida glabrata prosthetic valve endocarditis treated successfully with fluconazole plus caspofungin without surgery: a case report and literature review. Eur J Clin Microbiol Infect Dis 2005;24:753-755.

46. Del Castillo M, Wainsztein N, Klein F, Manganello S, Orellana N. Treatment with caspofungin of Candida tropicalis endocarditis resistant to fluconazol. Medicina 2004;64:152-154.

47. Bacak V, Biocina B, Starcevic B, Gertler S, Begovac J. Candida albicans endocarditis treatment with caspofungin in an HIV-infected patient-case report and review of literature. The Journal of Infection 2006;53:11-14.

48. Jiménez-Exposito MJ, Torres G, Baraldes A, Benito N, et al. Native valve endocarditis due to Candida glabrata treated without valvular replacement: a potential role for caspofungin in the induction and maintenance treatment. Clin Infect Dis 2004;39:70-73.

49. Prabhu RM, Orenstein R. Failure of caspofungin to treat brain abscesses secondary to Candida albicans prosthetic valve endocarditis. Clin Infect Dis 2004;39:1253-1254.

50. López-Ciudad V, Castro-Orjales MJ, León C, Sanz-Rodríguez C, et al. Successful treatment of Candida parapsilosis mural endocarditis with combined caspofungin and voriconazole. BMC infectious diseases 2006;6:73.

51. Mrowczynski W, Wojtalik M. Caspofungin for Candida endocarditis. The pediatric infectious disease journal 2004;23:376.

52. Phillips P, Shafran S, Garber G, Rotstein C, et al. Multicenter randomized trial of fluconazole versus amphotericin B for treatment of candidemia in non-neutropenic patients. Canadian Candidemia Study Group. Eur J Clin Microbiol Infect Dis 1997;16:337-345.

53. Spellberg BJ, Filler SG, Edwards Jr JE. Current treatment strategies for disseminated candidiasis. Clin Infect Dis 2006;42:244-251.

54. Rex JH, Walsh TJ, Sobel JD, et al. Practice guidelines for the treatment of candidiasis. Infectious Diseases Society of America. Clin Infect Dis 2000;30:662-678.

55. Pelz RK, Hendrix CW, Swoboda SM, et al. Double-blind placebo-controlled trial of fluconazole to prevent candidal infections in critically ill surgical patients. Ann Surg 2001;233:542-548.