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Larger populations at risk, broader use of antibiotics and longer hospital stays have impacted on the incidence of  Candida  sp. bloodstream infections (CBSI).    Objective  To determine clinical and epidemiologic characteristics of patients with CBSI in two tertiary care reference medical institutions in Mexico City.    Design  Prospective and observational laboratory-based surveillance study conducted from 07/2008 to 06/2010.    Methods  All patients with CBSI were included. Identification and antifungal susceptibility were performed using CLSI M27-A3 standard procedures. Frequencies, Mann-Whitney U test or T test were used as needed. Risk factors were determined with multivariable analysis and binary logistic regression analysis.    Results  CBSI represented 3.8% of nosocomial bloodstream infections. Cumulative incidence was 2.8 per 1000 discharges (incidence rate: 0.38 per 1000 patient-days).  C. albicans  was the predominant species (46%), followed by  C. tropicalis  (26%).  C. glabrata  was isolated from patients with diabetes (50%), and elderly patients. Sixty-four patients (86%) received antifungals. Amphotericin-B deoxycholate (AmBD) was the most commonly used agent (66%). Overall mortality rate reached 46%, and risk factors for death were APACHE II score ≥16 (OR = 6.94, CI 95%  = 2.34–20.58, p<0.0001), and liver disease (OR = 186.11, CI 95%  = 7.61–4550.20, p = 0.001). Full susceptibility to fluconazole, AmBD and echinocandins among  C. albicans, C. tropicalis,  and  C. parapsilosis  was observed.    Conclusions  The cumulative incidence rate in these centers was higher than other reports from tertiary care hospitals from Latin America. Knowledge of local epidemiologic patterns permits the design of more specific strategies for prevention and preemptive therapy of CBSI.

Surveillance of Candida spp Bloodstream Infections: Epidemiological Trends and Risk Factors of Death in Two Mexican Tertiary Care Hospitals