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Colegio de Medicina Interna de México.

2014, Number 2

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Med Int Mex 2014; 30 (2)

Risk Factors and Epidemiology of Candidemia at Hospital Juarez de Mexico

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

Language: Spanish
References: 55
Page: 121-132
PDF size: 677.99 Kb.


ABSTRACT

Background: There is an increased incidence of severe fungal infections, hence the importance of being able to identify predisposing factors and, with clinical criteria, to define the early onset of antifungal treatment.
Objective: To determine the risk factors for candidemia in adult patients and drug susceptibility and species of Candida sp at the Hospital Juarez of Mexico.
Material and method: A retrospective analysis was conducted from August 2012 to July 2013 in patients with candidemia, data were obtained from clinical files and the microbiology laboratory, seven strains were sent to the Mycology Laboratory of the Hospital Infantil de Mexico Federico Gomez to determine antifungal drug susceptibility and to identify the species of Candida sp.
Results: Eighteen cases were reported with candidemia. In seven cases Candida sp species were determined, the main one was Candida albicans, the Intensive Care Unit was the service with the highest number of cases. The 94.4% of patients had three points or more of Candida Score, the main risk factors for candidemia were total parenteral nutrition, severe sepsis, central venous catheters and multiple exposure to broad-spectrum antibiotics. Three strains were resistant to azoles.
Conclusions: The critically ill patients are more predisposed to candidemia, antibiotics, severe sepsis, total parenteral nutrition and invasive devices are major risk factors. Azoles resistance exists in Candida strains in our population, it is important routinely determining the drug susceptibility in order to give an effective prophylaxis and treatment.


REFERENCES

  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.




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