Open AccessEpidemiology and prognostic factors of nosocomial candidemia in Northeast Brazil: A six-year retrospective study
Author(s) -
Mariana Araújo Paulo de Medeiros,
Ana Patrícia Vieira de Melo,
Aurélio de Oliveira Bento,
Luanda Barbara Ferreira Canário de Souza,
Francisco de Assis Bezerra Neto,
J.M. Pino García,
Diana Luzia Zuza-Alves,
Elaine Cristina Francisco,
Analy Salles de Azevedo Melo,
Guilherme Maranhão Chaves
Publication year - 2019
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0221033
Subject(s) - medicine , candida glabrata , candida parapsilosis , univariate analysis , epidemiology , candida tropicalis , fluconazole , mortality rate , retrospective cohort study , incidence (geometry) , odds ratio , sepsis , fungemia , multivariate analysis , surgery , mycosis , antifungal , physics , dermatology , optics
Candidemia has been considered a persistent public health problem with great impact on hospital costs and high mortality. We aimed to evaluate the epidemiology and prognostic factors of candidemia in a tertiary hospital in Northeast Brazil from January 2011 to December 2016. Demographic and clinical data of patients were retrospectively obtained from medical records and antifungal susceptibility profiling was performed using the broth microdilution method. A total of 68 episodes of candidemia were evaluated. We found an average incidence of 2.23 episodes /1000 admissions and a 30-day mortality rate of 55.9%. The most prevalent species were Candida albicans (35.3%), Candida tropicalis (27.4%), Candida parapsilosis (21.6%) and Candida glabrata (11.8%). Higher mortality rates were observed in cases of candidemia due to C . albicans (61.1%) and C . glabrata (100%), especially when compared to C . parapsilosis (27.3%). Univariate analysis revealed some variables which significantly increased the probability of death: older age ( P = 0.022; odds ratio [OR] = 1.041), severe sepsis ( P < 0.001; OR = 8.571), septic shock ( P = 0.035; OR = 3.792), hypotension ( P = 0.003; OR = 9.120), neutrophilia ( P = 0.046; OR = 3.080), thrombocytopenia ( P = 0.002; OR = 6.800), mechanical ventilation ( P = 0.009; OR = 8.167) and greater number of surgeries ( P = 0.037; OR = 1.920). Multivariate analysis showed that older age ( P = 0.040; OR = 1.055), severe sepsis ( P = 0.009; OR = 9.872) and hypotension ( P = 0.031; OR = 21.042) were independently associated with worse prognosis. There was no resistance to amphotericin B, micafungin or itraconazole and a low rate of resistance to fluconazole (5.1%). However, 20.5% of the Candida isolates were susceptible dose-dependent (SDD) to fluconazole and 7.7% to itraconazole. In conclusion, our results could assist in the adoption of strategies to stratify patients at higher risk for developing candidemia and worse prognosis, in addition to improve antifungal management.