Species distribution and susceptibility profile of yeasts isolated from blood cultures: results of a multicenter active laboratory-based surveillance study in Argentina

The Mycology Department of the Instituto Nacional de Enfermedades Infecciosas "Dr. C. Malbrán", conducted the Second National Multicenter Survey on Fungemia due to Yeasts in Argentina. The aim was to obtain updated data of the frequency of the causative species encountered and their in vitro susceptibility to seven antifungal agents. Yeast species were identified by micromorphological and biochemical studies. Antifungal susceptibility testing was performed by the reference microdilution method E.Def 7.1 of the European Committee on Antibiotic Susceptibility Testing (EUCAST). A total of 461 viable yeasts were identified. The most frequent species were: Candida albicans (38.4 %), Candida parapsilosis (26 %), Candida tropicalis (15.4 %) and Candida glabrata (4.3 %). Other uncommon species, such as Candida viswanathii (0.6 %), Candida haemulonii (0.4 %), Candida inconspicua (0.2 %) and Candida fermentati (0.2 %) were also isolated. Among the Candida spp., 5.4 % and 1.6 % were resistant to fluconazole and voriconazole, respectively. Itraconazole and caspofungin were the most efficient agents against all Candida spp. tested (MIC < 1 mg/l). For anidulafungin, 21.6 % of C. parapsilosis showed a MIC value of 4 mg/l. Fluconazole was less active against 53.1 % of Cryptococcus neoformans (MIC > 8 mg/l), 75 % of Trichosporon spp., and 100 % of Rhodotorula spp., Geotrichum candidum, Saccharomyces cerevisiae. The global percentage of mortality was 20 %. The presence of uncommon species reinforces the need for performing continuous laboratory surveillance in order to monitor possible changes, not only in the epidemiological distribution of species, but also in the resistance to antifungal drugs.

Distribución de especies y perfil de sensibilidad de levaduras aisladas de hemocultivos: resultados de un estudio multicéntrico de vigilancia de laboratorio en Argentina. El Departamento Micología del Instituto Nacional de Enfermedades Infecciosas "Dr. Carlos G. Malbrán" condujo el segundo estudio multicéntrico nacional sobre funge- mias debidas a levaduras. El objetivo fue obtener datos actualizados sobre la distribución de especies y la sensibilidad in vitro frente a siete antifúngicos. Las levaduras fueron identificadas mediante el estudio de la micromorfología y la realización de pruebas bioquímicas. La determinación de la sensibilidad se realizó según el método de referencia E.Def 7.1 del European Committee on Antibiotic Susceptibility Testing (EUCAST). Se identificaron 461 levaduras. Las especies más frecuentes fueron Candida albicans (38,4 %), Candida parapsilosis (26 %), Candida tropicalis (15,4 %) y Candida glabrata (4,3 %). Se aislaron otras especies menos comunes, como Candida viswanathii (0,6 %), Candida haemulonii (0,4 %), Candida inconspicua (0,2 %) y Candida fermentati (0,2 %). Entre las especies del género Candida, el 5,4 % y el 1,6 % fueron resistentes al fluconazol y al voriconazol, respectivamente. El itraconazol y la caspofungina fueron los antifúngicos más eficaces in vitro frente a las especies de Candida evaluadas (CIM < 1 mg/l). Para la anidulafungina, el 21,6 % de los aislamientos de C. parapsilosis mostraron una CIM de 4 mg/l. El fluconazol fue menos activo para el 53,1 % de los aislamientos de Cryptococcus neoformans (CIM > 8 mg/l), el 75 % de los aislamientos de Trichosporon spp. y el 100 % de los aislamientos de Rhodotorula spp., Geotrichum candidum y Saccharomyces cerevisiae. El porcentaje de mortalidad fue del 20 %. La presencia de especies infrecuentes refuerza la necesidad de realizar la continua vigilancia de laboratorio con el fin de monitorear posibles cambios, no solo en la epidemiología de las especies causantes de fungemia, sino también en la resistencia a los antifúngicos.

Candida bloodstream infection: data from a teaching hospital in Mato Grosso do Sul, Brazil / Infecção na corrente sangüínea por Candida spp. dados de um hospital universitário em Mato Grosso do Sul, Brasil

The incidence of Candida bloodstream infection has increased over the past years. In the Center-West region of Brazil, data on candidemia are scarce. This paper reports a retrospective analysis of 96 cases of Candida bloodstream infection at a Brazilian tertiary-care teaching hospital in the state of Mato Grosso do Sul, from January 1998 to December 2006. Demographic, clinical and laboratory data were collected from medical records and from the hospital's laboratory database. Patients' ages ranged from three days to 92 years, with 53 (55.2 percent) adults and 43 (44.8 percent) children. Of the latter, 25 (58.1 percent) were newborns. The risk conditions most often found were: long period of hospitalization, utilization of venous central catheter, and previous use of antibiotics. Fifty-eight (60.4 percent) patients died during the hospitalization period and eight (13.7 percent) of them died 30 days after the diagnosis of candidemia. Candida albicans (45.8 percent) was the most prevalent species, followed by C. parapsilosis (34.4 percent), C. tropicalis (14.6 percent) and C. glabrata (5.2 percent). This is the first report of Candida bloodstream infection in the state of Mato Grosso do Sul and it highlights the importance of considering the possibility of invasive Candida infection in patients exposed to risk factors, particularly among neonates and the elderly.

A incidência de infecções na corrente sangüínea causada por Candida spp. tem aumentado nos últimos anos. Na região Centro-Oeste do Brasil, os dados sobre candidemia são escassos. Realizamos uma análise retrospectiva de casos de infecção na corrente sangüínea por Candida em um hospital terciário de ensino de Mato Grosso do Sul. Noventa e seis episódios diagnosticados de janeiro de 1998 a dezembro de 2006 foram incluídos no estudo. Os dados demográficos e clínicos foram obtidos de prontuários; os dados laboratoriais provieram de registros do laboratório hospitalar. Dos pacientes, 43 (44,8 por cento) eram crianças e 53 (55,2 por cento) adultos, com idades variando de três dias a 92 anos. Das crianças, 25 (58,1 por cento) eram recém-nascidas. As condições de risco mais encontradas foram: prolongado tempo de internação, uso de cateter venoso central e uso prévio de antibióticos. Cinqüenta e oito (60,4 por cento) pacientes foram a óbito durante a hospitalização e oito (13,7 por cento) deles foram a óbito 30 dias após o diagnóstico de candidemia. Candida albicans (45,8 por cento) foi a espécie mais prevalente seguida por C. parapsilosis (34,4 por cento), C. tropicalis (14,6 por cento) e C. glabrata (5,2 por cento). Esta é a primeira descrição de infecção na corrente sangüínea por espécies de Candida em Mato Grosso do Sul, confirmando a importância da suspeita clínica de infecções invasivas por tais microrganismos na evolução de pacientes expostos a fatores de risco, principalmente no caso de idosos e neonatos.

Rhodotorula glutinis fungemia: a case report and literatura review

A fatal case of Rhodotorula glutinis fungenia in an 11-year-old boy with acute lymphoblastc leukemia undergoing third reinduction chemotherapy is reported. This is the first case of fungemia by Rhodotorula glutinis reported in Brazil.

Mortality associated with systemic candidiasis in children

The purpose of this study was to determine factor asociated with an increased risk of mortality due to systemic Candida infections in children hospitalized at our tertiary care facility. A total of 71 cases of Candida bloodstream infections were identified over a 2-year period. The attack rate was 47 cases of candidemia per 10,000 discharges and the case fatality rate was 46.5 percent. Sixty-one cases occurred in infants under 2 years; 27 were newborns (38 percent). Using logistic regression analysis, we evaluated the independent effects of potential risk factors for death due to candidemia. Three factors were associated with the subsequent risk for death due to systemic candida infection: malnutrition (OR=4.3; 95 percent CI 1.2-14.8), prior surgery (OR=3.8; 95 percent CI 1.2-13.2), and the number of days between the first positive candida blood culture and the onset of antifungal treatment (OR= 1.12; 95 percent CI 1.6-1.25). Newborns showed an almost three times greater risk of death due to candidemias as compared to other age groups, but this association was only marginally significant (OR= 2.8; 95 percent CI 0.9 - 9.3). There was no difference in the rate of candidemia between the 2 years of the study; however, the observed mortality declined significantly from 65 percent in year one to 20 percent in year two (p=0.02). The major finding of this study was to observe that for every day treatment was delayed the risk of death increased significantly. Thus, this study provides support for empirical antifungal therapy early in the course of suspected systemic candidiasis i order to improve survival among children