Candida: epidemiología y factores de riesgo para especies no albicans / Candida: Epidemiology and risk factors for non-albicans species

Introducción La incidencia de infecciones fúngicas nosocomiales aumentó significativamente en la última década. La detección de Candida en muestras clínicas puede representar una colonización, infección local (muguet) o infección invasiva (candidemia). Conocer las especies aisladas facilita la elección del mejor tratamiento. El objetivo de este trabajo es determinar la frecuencia y la distribución de especies de Candida spp. detectadas en muestras clínicas, analizar las características clínicas de la población involucrada y determinar los factores de riesgo para especies Candida no albicans. Métodos Estudio retrospectivo, observacional, de 2006 a 2010, que incluye las detecciones de Candida en muestras clínicas de pacientes internados al menos 48 h en un centro neurológico. Se analizaron características epidemiológicas, comorbilidades, factores de riesgo, factores asociados a la detección de especies no albicans, tratamiento antifúngico, episodios adversos y mortalidad. Resultados Se detectaron 321 Candida spp. de muestras clínicas: C. albicans 139 (43,3%) y Candida no albicans 182 (56,7%). La distribución de las muestras fue orina 122 (Candida no albicans 67,2%), vía aérea 81 y fauces 45 (C. albicans 58 y 66,6%, respectivamente), candidemia 40 (Candida no albicans 75%: C. tropicalis 11, C. parapsilosis 9). La comorbilidad más usual fue el tumor sólido (35,5%). Los factores de riesgo hallados más frecuentes fueron el tratamiento antibiótico (85,5%), el tratamiento con esteroides (61,7%) y los pacientes internados en la UCI al diagnóstico (61,6%). El análisis de los factores de riesgo y el aislamiento de Candida no albicans muestra que la quimioterapia, la cirugía previa y el tratamiento con aminopenicilinas, carbapenems y glucopéptidos fueron (..) (AU)

Introduction Nosocomial fungal infections have increased significantly in the last decade. Candida detection in clinical specimens can mean either colonization or an infection which can be local (muguet) or invasive. Knowledge of the species helps in choosing the best treatment. The aims of this study were to determine the frequency and distribution of Candida species detected in clinical samples, to analyze the clinical characteristics of the involved population and to determine the risk factors for Candida non-albicans species. Methods Retrospective, observational. Period: 2006-2010. Inclusion criteria: all isolates of Candida in clinical specimens from patients hospitalized —at least 48 hours in a neurological center. We analyzed epidemiological characteristics, co morbidities, risk factors, factors associated with Candida non-albicans detection, antifungal treatment, development of adverse events and mortality. Results Candida spp. was isolated from 321 clinical specimens: 139 (43.3%) were C. albicans and 182 (56.7%) Candida non-albicans. The distribution of the sample was: urine 122 (Candida non-albicans 67.2%), airway 81, oropharynx 45 (C. albicans) and candidemia 40 (Candida non-albicans 75%). The most frequent co-morbidity was solid tumor (35.5%). The main risk factors were antibiotic therapy (85.5%), steroid therapy (61.7%) and in ICU at diagnosis (61.6%). The analysis of risk factors and the isolation of Candida non-albicans shows that chemotherapy, previous surgery, treatment with aminopenicillins, carbapenems and glycopeptides were statistically significant (P < .05). There is a trend in neutropenic (..) (AU)

[Candida: epidemiology and risk factors for non-albicans species]. / Candida: epidemiología y factores de riesgo para especies no albicans.

INTRODUCTION: Nosocomial fungal infections have increased significantly in the last decade. Candida detection in clinical specimens can mean either colonization or an infection which can be local (muguet) or invasive. Knowledge of the species helps in choosing the best treatment. The aims of this study were to determine the frequency and distribution of Candida species detected in clinical samples, to analyze the clinical characteristics of the involved population and to determine the risk factors for Candida non-albicans species. METHODS: Retrospective, observational. PERIOD: 2006-2010. INCLUSION CRITERIA: all isolates of Candida in clinical specimens from patients hospitalized at least 48 hours in a neurological center. We analyzed epidemiological characteristics, co morbidities, risk factors, factors associated with Candida non-albicans detection, antifungal treatment, development of adverse events and mortality. RESULTS: Candida spp. was isolated from 321 clinical specimens: 139 (43.3%) were C. albicans and 182 (56.7%) Candida non-albicans. The distribution of the sample was: urine 122 (Candida non-albicans 67.2%), airway 81, oropharynx 45 (C. albicans) and candidemia 40 (Candida non-albicans 75%). The most frequent co-morbidity was solid tumor (35.5%). The main risk factors were antibiotic therapy (85.5%), steroid therapy (61.7%) and in ICU at diagnosis (61.6%). The analysis of risk factors and the isolation of Candida non-albicans shows that chemotherapy, previous surgery, treatment with aminopenicillins, carbapenems and glycopeptides were statistically significant (P<.05). There is a trend in neutropenic patients (P=.055) and in ICU at diagnosis (P=.076). Overall survival was 71%. CONCLUSIONS: Candida species distribution varies with the type of sample analyzed. Non-albicans species make up the majority of the isolates. The identification of the species involved per sample helps to optimize treatment. The high frequency of isolation of Candida in patients on steroids and antibiotics and admitted to ICU, is worth pointing out. Patients with previous surgery, treated with the aforementioned antibiotics or chemotherapy, could receive non-azole antifungals in the initial empirical treatment strategy.