Clinical and mycological characteristics of hospitalized patients with candidemia
Keywords:
antifungals, candidemia, Candida parapsilosis, mortality.Abstract
Introduction: Candidemia is an entity that has increased in the hospital environment. It frequently affects patients treated in Critical Care Units, with a predominance of isolates sensitive to available antifungals. Species of the Candida parapsilosis complex are largely responsible for causing severe infections in some regions.Objective: Characterize hospitalized patients with candidemia from a clinical and microbiological point of view.
Methods: An observational, descriptive, cross-sectional study was carried out on 234 patients with a presumptive diagnosis of candidemia. The recovered isolates were characterized by phenotypic microbiological methods. Clinical variables, results of blood cultures, population group and deaths due to candidiasis and microbiological variables: Isolates in the positive samples and susceptibility profile to antifungals, were analyzed. As summary measures for data analysis, absolute frequencies and percentages were used.
Results: 51 cases with candidemia were confirmed in the Critical Care Units (21.79%); 52.94% corresponding to neonates. Non-albicans species predominated, such as the Candida parapsilosis complex (80.39%) and Candida tropicalis (9.80%). Amphotericin B and 5-fluorocytosine were the most active antifungals. Overall mortality was 25.49%.
Conclusions: Hospitalized patients with candidemia are characterized by being of neonatal age, with the Candida parapsilosis complex, high sensitivity to antifungals and a high mortality rate.
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References
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2. Mohr A, Simon M, Joha T, Hanses F, Salzberger B, Hitzenbichler F. Epidemiology of candidemia and impact of infectious disease consultation on survival and care [Internet]. Infection. 2020; 48(2):275-84. DOI: 10.1007/s15010-020-01393-9
3. Cruz Choappa R, Vieille Oyarzo P. nuevos nombres para antiguas especies fúngicas de importancia médica. [Internet]. Rev. Chil. Infectol. 2023 [acceso: 21/7/2024]; 40(5):461-4. Disponible en: https://www.scielo.cl/scielo.php? script=sci_arttext&pid=S0716-10182023000500461&Ing=es
4. CLSI. Performance Standards for Antifungal Susceptibility Testing of Yeats [Internet]. 3rd ed. CLSI supplement M27M44S. Clinical Laboratory Standards Institute; 2022. [acceso: 01/10/2023]. Disponible en: https://clsi.org/standards/products/microbiology/documents/m27m44s/
5. Cortés JA, Ruiz JF, Melgarejo-Moreno LN, Lemos EV. Candidemia en Colombia [Internet]. Biomédica. 2020;40(1):195-207. DOI: 10.7705/biomedica.4400
6. WHO fungal priority pathogens list to guide research, development and public health action. Geneva: World Health Organization [Internet]. 2022 [acceso: 01/10/2023]. Disponible en: https://www.who.int/publications/i/item/9789240060241
7. McGinnis MR. Laboratory Handbook of Medical Mycology [Internet]. Academy Press INC. New York. 2012 [acceso: 01/10/2023]. Disponible en: https://shop.elsevier.com/books/laboratory-handbook-of-medical-mycology/mcginnis/978-0-12-482850-6
8. Manual del Sistema Comercial de Determinación de Susceptibilidad Antifúngica en Levaduras ATB TM FUNGUS 3 [Internet]. Francia: bioMèrieux SA; 2008 [acceso: 01/10/2023]. Disponible en: https://www.biomerieux.es/sites/subsidiary_es/files/biom_clinica_2023_esp_ver_sp.pdf
9. CLSI. Reference method for broth dilution antifungal susceptibility testing of yeasts [Internet]. 3rd ed. CLSI document M27-A3. Clinical Laboratory Standards Institute; 2008. [acceso: 01/10/2023]. Disponible en: https://clsi.org/media/1461/m27a3_sample.pdf
10. World Medical Association (WMA). WMA Declaration of Helsinki - Ethical principles for medical research involving human subjects. Fortaleza: 64th WMA General Assembly; 2013. [acceso: 01/10/2023]. Disponible en: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/
11. Domínguez Céspedes L, Céspedes Fonseca YM, Leyva Pérez Y. Caracterización clínico - micológica de candidiasis sistémica en niños. Hospital Pediátrico Provincial. Holguín. 2015 [Internet]. Hechos Microbiol. 2021; 12(2):24-34. DOI: 10.17533/udea.hm.v12n2a03
12. García Gómez D, Abreu Duarte R, Mesa Coello L, López Pérez M, Adjudah Truffín C. Situación actual de la candidiasis sistémica en pacientes hospitalizados [Internet]. Acta Méd Centro. 2020 [acceso: 02/02/2024]; 14(2):182-192. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=95611
13. González Lorenzo L, García Gómez D, Castro Martínez JA, López Pérez M, Truffín Truffín EG. Comportamiento de Candida en niños hospitalizados en unidades de cuidados intensivos [Internet]. Medicentro Electrónica. 2023 [acceso: 02/02/2024]; 27(1):e3829. Disponible en: http://scielo.sld.cu/scielo.php?pid=S1029-30432023000100003&script=sci_arttext&tlng=en
14. Pfaller MA, Diekema DJ, Turnidge JD, Castanheira M, Jones RN. Twenty years of the SENTRY Antifungal Surveillance Program: results for Candida species from 1997-2016 [Internet]. Open Forum Infect Dis. 2019; 6(Suppl 1):79-94. DOI: 10.1093/ofid/ofy358
15. Reda NM, Hassan RM, Salem ST, Yousef RHA. Prevalence and species distribution of Candida bloodstream infection in children and adults in two teaching university hospitals in Egypt: first report of Candida kefyr [Internet]. Infection. 2023; 51(2):389-95. DOI: 10.1007/s15010-022-01888-7
16. Kord M, Salehi M, Hashemi SJ, Abdollahi A, Alijani N, Maleki A, et al. Clinical, epidemiological, and mycological features of patients with candidemia: Experience in two tertiary referral centers in Iran [Internet]. Curr Med Mycol. 2022; 8(3):9-17. DOI: 10.18502/cmm.8.3.11207
17. Chibabhai V. Incidence of candidemia and prevalence of azole-resistant candidemia at a tertiary South African hospital - A retrospective laboratory analysis 2016-2020 [Internet]. S Afr J Infect Dis. 2022; 37(1):326. DOI: 10.4102/sajid.v37i1.326
18. Galia L, Pezzani MD, Compri M, Callegari A, Rajendran NB, Carrara E, et al. Surveillance of Antifungal Resistance in Candidemia Fails to Inform Antifungal Stewardship in European Countries [Internet]. J. Fungi. 2022; 8(3):249. DOI: 10.3390/jof8030249
19. Boattini M, Pinto MF, Christaki E, Fasciana T, Falces-Romero I, Tofarides A, et al. Multicentre Surveillance of Candida Species from Blood Cultures during the SARS-CoV-2 Pandemic in Southern Europe (CANCoVEU Project) [Internet]. Microorganisms. 2023; 11(3):560. DOI: 10.3390/microorganisms11030560
20. Mesini A, Mikulska M, Giacobbe DR, Del Puente F, Gandolfo N, Codda G, et al. Changing epidemiology of candidemia: Increase in fluconazole-resistant Candida parapsilosis [Internet]. Mycoses. 2020; 63(4):361-8. DOI: 10.1111/myc.13050
21. Perurera Lancha M, Pérez Muñoz Y, Fernández Andreu CM, Martínez Machín G, Illnait Zaragozí MT. Susceptibilidad antifúngica de aislados vaginales de Candida spp. [Internet]. Rev Cubana Med Trop. 2016 [acceso: 02/02/2024]; 68(3):248-54. Disponible en: http://scielo.sld.cu/scielo.php?pid=S0375-07602016000300007&script=sci_arttext
22. Philips S, Van Hoecke F, De Laere E, Vervaeke S, De Smedt R, Boelens J, et al. Comparison of Two Commercial Colorimetric Broth Microdilution Tests for Candida Susceptibility Testing: Sensititre YeastOne versus MICRONAUT-AM [Internet]. J Fungi. 2021; 7(5):356. DOI: 10.3390/jof7050356
23. Arastehfar A, Yazdanpanah S, Bakhtiari M, Fang W, Pan W, Mahmoudi S, et al. Epidemiology of candidemia in Shiraz, southern Iran: A prospective multicenter study (2016-2018) [Internet]. Med Mycol. 2021; 59(5):422-30. DOI: 10.1093/mmy/myaa059
24. Hawser S, Morrissey I, Kothari N, Ghannoum M. Analysis of Resistance In Antifungals (ARIA)-Surveillance of Candida spp. isolates collected from Europe in 2019. [Internet]. En: 32nd European Congress of Clinical Microbiology & Infectious Deseases; 20 October 2022; Lisbon, Portugal: International Health Management Associates. [acceso: 04/02/2024]. Disponible en: https://www.ihma.com/app/uploads/ARIA_IHMA_EUROPE_GHANNOUM_ECCMID_2022.pdf
25. Thomaz DY, Del Negro GMB, Ribeiro LB, da Silva M, Carvalho GOMH, Camargo CH, et al. A Brazilian Inter-Hospital Candidemia Outbreak Caused by Fluconazole-Resistant Candida parapsilosis in the COVID-19 Era [Internet]. J Fungi. 2022; 8(2):100. DOI: 10.3390/jof8020100
26. Hare RK, Arastehfar A, Rosendahl S, Charsizadeh A, Daneshnia F, Eshaghi H, et al. Candidemia among Hospitalized Pediatric Patients Caused by Several Clonal Lineages of Candida parapsilosis [Internet]. J Fungi. 2022; 8(2):183. DOI: 10.3390/jof8020183
Published
2024-10-01
How to Cite
1.
García Gómez D, Perurena Lancha MR, Choy Marrero A, López Pérez M, Ilnait Zaragozí MT. Clinical and mycological characteristics of hospitalized patients with candidemia. Rev Cubana Med Milit [Internet]. 2024 Oct. 1 [cited 2025 Jan. 30];53(4):e024058713. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/58713
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Clinical Practice Article
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