Epidemiology and prognostic factors of nosocomial candidemia in Northeast Brazil: A six-year retrospective study

• Published in: PloS one Vol. 14; no. 8; p. e0221033
• Main Authors: Medeiros, Mariana Araújo Paulo de, Melo, Ana Patrícia Vieira de, Bento, Aurélio de Oliveira, Souza, Luanda Bárbara Ferreira Canário de, Neto, Francisco de Assis Bezerra, Garcia, Jarmilla Bow-Ltaif, Zuza-Alves, Diana Luzia, Francisco, Elaine Cristina, Melo, Analy Salles de Azevedo, Chaves, Guilherme Maranhão
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 22.08.2019; Public Library of Science (PLoS)
• Subjects: Adult; Age Factors; Aged; Amphotericin B; Analysis; Analysis of Variance; Anidulafungin; Antifungal agents; Antifungal Agents - therapeutic use; Antiparasitic agents; Biology and Life Sciences; Blood; Brazil - epidemiology; Candida albicans; Candida albicans - drug effects; Candida albicans - growth & development; Candida albicans - pathogenicity; Candida glabrata - drug effects; Candida glabrata - growth & development; Candida glabrata - pathogenicity; Candida parapsilosis - drug effects; Candida parapsilosis - growth & development; Candida parapsilosis - pathogenicity; Candida tropicalis - drug effects; Candida tropicalis - growth & development; Candida tropicalis - pathogenicity; Candidemia; Candidemia - diagnosis; Candidemia - drug therapy; Candidemia - epidemiology; Candidemia - mortality; Candidiasis; Care and treatment; Caspofungin; Criminal investigation; Cross Infection - diagnosis; Cross Infection - drug therapy; Cross Infection - epidemiology; Cross Infection - mortality; Demographics; Drug Resistance, Fungal; Epidemiology; Female; Fluconazole; Fungicides; Health care costs; Hospitals; Humans; Hypertension - diagnosis; Hypertension - physiopathology; Hypotension; Incidence; Infections; Internal medicine; Itraconazole; Laboratories; Male; Mechanical ventilation; Medical prognosis; Medical records; Medicine; Medicine and Health Sciences; Micafungin; Middle Aged; Mortality; Multivariate analysis; Neutrophilia; Nosocomial infection; Patients; Profiling; Prognosis; Public health; Research and Analysis Methods; Respiration, Artificial - adverse effects; Respiration, Artificial - statistics & numerical data; Retrospective Studies; Risk Factors; Sepsis; Septic shock; Shock; Shock, Septic - diagnosis; Shock, Septic - drug therapy; Shock, Septic - epidemiology; Shock, Septic - mortality; Surgery; Surveillance; Survival Analysis; Tertiary Care Centers; Thrombocytopenia; Thrombocytopenia - diagnosis; Thrombocytopenia - physiopathology; Ventilation; Vital signs; Brazil; Rio Grande do Norte Brazil; Italy; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0221033

Candidemia has been considered a persistent public health problem with great impact on hospital costs and high mortality. We aimed to evaluate the epidemiology and prognostic factors of candidemia in a tertiary hospital in Northeast Brazil from January 2011 to December 2016. Demographic and clinical data of patients were retrospectively obtained from medical records and antifungal susceptibility profiling was performed using the broth microdilution method. A total of 68 episodes of candidemia were evaluated. We found an average incidence of 2.23 episodes /1000 admissions and a 30-day mortality rate of 55.9%. The most prevalent species were Candida albicans (35.3%), Candida tropicalis (27.4%), Candida parapsilosis (21.6%) and Candida glabrata (11.8%). Higher mortality rates were observed in cases of candidemia due to C. albicans (61.1%) and C. glabrata (100%), especially when compared to C. parapsilosis (27.3%). Univariate analysis revealed some variables which significantly increased the probability of death: older age (P = 0.022; odds ratio [OR] = 1.041), severe sepsis (P < 0.001; OR = 8.571), septic shock (P = 0.035; OR = 3.792), hypotension (P = 0.003; OR = 9.120), neutrophilia (P = 0.046; OR = 3.080), thrombocytopenia (P = 0.002; OR = 6.800), mechanical ventilation (P = 0.009; OR = 8.167) and greater number of surgeries (P = 0.037; OR = 1.920). Multivariate analysis showed that older age (P = 0.040; OR = 1.055), severe sepsis (P = 0.009; OR = 9.872) and hypotension (P = 0.031; OR = 21.042) were independently associated with worse prognosis. There was no resistance to amphotericin B, micafungin or itraconazole and a low rate of resistance to fluconazole (5.1%). However, 20.5% of the Candida isolates were susceptible dose-dependent (SDD) to fluconazole and 7.7% to itraconazole. In conclusion, our results could assist in the adoption of strategies to stratify patients at higher risk for developing candidemia and worse prognosis, in addition to improve antifungal management.