Prevalence, susceptibility profile for fluconazole and risk factors for candidemia in a tertiary care hospital in southern Brazil
Prevalence, susceptibility profile for fluconazole and risk factors for candidemia in a tertiary care hospital in southern Brazil
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DOI：
10.1590/s1413-86702005000500009
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发表时间：
2005-10-01
影响因子：
3.4
通讯作者：
Barth, Afonso Luis
中科院分区：
文献类型：
--
作者：
Aquino, Valério Rodrigues;Lunardi, Luciano W.;Barth, Afonso Luis
念珠菌引起的血液感染在临床上和流行病学上都非常重要，因为它的死亡率很高，而且越来越多的非白色念珠菌具有更强的耐药性（不同的易感性）。我们通过一项回顾性研究，从住院患者的阳性培养开始，研究了巴西南部阿雷格里港临床医院（Hospital de Clinicas de Porto Alegre）假丝酵母菌对氟康唑的物种流行率和敏感性，以及假丝酵母菌院内感染的风险。131次记录事件的种类分布情况为：白色念珠菌（45%）、副假丝酵母菌（24.4%）、热带假丝酵母菌（15.3%）、光假丝酵母菌（6.9%）、克氏假丝酵母菌（4.6%）和其他假丝酵母菌（pelicullosa、guilliermondii、lusitaniae和kefyr）。绝大多数标本（121 ~ 92.4%）对氟康唑敏感；耐药或剂量依赖性敏感的样品仅包括克氏金针菇和光秃金针菇。35.0%的念珠菌发作伴有血液病（白血病、淋巴瘤）或肿瘤（实体瘤）。我们注意到128例（97.7%）患者既往使用过抗生素，其中79.7%在念珠菌发作前使用过三种或三种以上抗生素。其他危险因素包括94例（71.8%）患者使用中心静脉导管，32例（24.4%）患者进行腹部手术。总死亡率为51.9%，因潜在疾病而异。我们发现白色念珠菌是最常见的菌种，尽管非白色念珠菌占多数。然而，体外对氟康唑的抗性仅在对偶氮化合物具有抗性的物种（C. glabrata和C. krusei）中检测到。既往使用抗生素和使用中心静脉导管是念珠菌病患者的主要危险因素。
Bloodstream infections caused by yeast, Candida spp, are quite important clinically and epidemiologically due to a high mortality rate and an increasing number of non-albicans species with a more resistant (differentiated susceptibility) profile. We examined species prevalence and susceptibility profile for fluconazole and the risk for nosocomial infections by Candida spp at the Hospital de Clinicas de Porto Alegre, a general tertiary care hospital in southern Brazilian, through a retrospective study, beginning with positive cultures of hospitalized patients. The distribution by species in 131 documented episodes was as follows: Candida albicans (45%), C. parapsilosis (24.4%), C. tropicalis (15.3%), C. glabrata (6.9%), C. krusei (4.6%) and 3.8% other species (C. pelicullosa, C. guilliermondii, C. lusitaniae and C. kefyr). The vast majority of samples (121- 92.4%) were susceptible to fluconazole; the resistant or dose-dependent sensitive samples included only C. krusei and C. glabrata. Blood diseases (leukemia, lymphoma), or neoplasias (solid tumors), were found in 35.0% of the candidemia episodes. We noted the previous use of antibiotics in 128 (97.7%) patients, with 79.7% using three or more antibiotics before the candidemia episode. Other risk factors included a central venous catheter in 94 (71.8%) and abdominal surgery in 32 (24.4%) patients. The overall mortality rate was 51.9%, which varied according to the underlying disease. We found that C. albicans was the most prevalent species, although the non-albicans species predominated. However, in vitro resistance to fluconazole was detected only among the species (C. glabrata and C. krusei) that tend to be resistant to the azolic compounds. Previous use of antibiotic and the use of a central venous catheter were the main risk factors among patients with candidemia.