Article

Distribución y sensibilidad a los antifúngicos de aislamientos clínicos deCandida en seis centros de salud del área metropolitana de Caracas, Venezuela (años 2003-2005)

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Abstract

El objetivo de este estudio fue conocer la frecuencia y la sensibilidad a los antifúngicos de aislamientos clínicos de Candida provenientes de pacientes con candidiasis en seis centros de salud del área metropolitana de Caracas, Venezuela. Se revisaron retrospectivamente los informes de laboratorio desde enero de 2003 hasta agosto de 2005. La identificación de las levaduras aisladas se realizó por los métodos convencionales y se evaluó la susceptibilidad a los antifúngicos por los métodos ATB-Fungus (bioMérieux, Francia) y Etest (AB Biodisk, Solna, Suecia). Se aislaron 1.977 levaduras y a 1.414 se les realizaron pruebas de sensibilidad. Candida albicans fue la levadura aislada con más frecuencia (46,7%) y el resto de las especies de Candida representaron más de la mitad de los aislamientos (53,4%). Todas las levaduras evaluadas presentaron valores de CMI <1 μg/ml para la anfotericina B y porcentajes de sensibilidad variable al fluconazol (91,5%), itraconazol (80%) y voriconazol (98,6%).

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... La candidiasis invasora en Venezuela, es causa principal de morbilidad y mortalidad. El Complejo de especies Candida es la segunda fuente de afección mórbida en casos de enfermedad fúngica en individuos inmunosuprimidos en años recientes (Dolande et al. 2008, Martínez et al. 2013, Lemus-Espinoza et al. 2019. ...
... Adicionalmente, en pacientes hospitalizados venezolanos se han aislado Candida glabrata, Candida tropicalis, Candida krusei y más recientemente Candida auris. Los factores de riesgos, como la cirugía abdominal complicada, tumores sólidos, neoplasias hematológicas, trasplantes y tratamientos prolongados con corticoides son comunes en esos casos (Dolande et al. 2008, Calvo et al. 2016, Bravo et al 2018, Lemus-Espinoza et al. 2018. ...
... La distribución epidemiológica de estos hongos varía según regiones geográficas y centros de salud, donde sin duda, es fundamental la identificación del agente etiológico y el conocimiento de su susceptibilidad (Dolande et al. 2008, Calvo et al. 2010, Martínez et al. 2013. ...
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estudio retrospectivo (n = 412), que determinó la frecuencia de levaduras en pacientes hospitalizados con impresión diagnóstica de candidiasis en el estado Anzoátegui, Venezuela. La identificación se realizó con CHROMagar Candida® y API AUX 20®. Adicionalmente, se evaluó susceptibilidad in vitro a cinco antifúngicos sistémicos con ATB-Fungus® (bioMérieux, Francia). Dos géneros se identificaron: Candida (99,8%) y Trichosporon (0,2%). Candida no-albicans representó la mayor prevalencia (55,1%) sobre Candida albicans (n = 184; 44,7%). También se aislaron levaduras del Complejo Candida parapsilosis (n = 163; 39,6%), Candida tropicalis (n = 46; 11,2%), Complejo Candida glabrata (n = 13; 3,2%), Candida krusei (n = 4; 1,0%). Menos frecuentes Candida lusitaniae y Trichosporon asahii (n = 1; 0,2%). El 90% de los aislamientos de C. albicans mostraron sensibilidad a fluconazol, mientras que el Complejo C. parapsilosis, C. tropicalis y el Complejo C. glabrata presentaron sensibilidad del 87%, 63% y 54%, respectivamente. Cinco (5/7) levaduras evidenciaron resistencia cruzada a los azoles (fluconazol e itraconazol): Complejo C. albicans (1,1%), Complejo C. parapsilosis (1,8%), C. tropicalis (4,3%), y C. krusei (75%). El Complejo C. glabrata presentó resistencia cruzada a todos los azoles (7,7%). Los resultados muestran una mayor frecuencia de C. no-albicans en pacientes hospitalizados, con predominio de C. parapsilosis. Se recomienda reforzar medidas para evitar colonización en pacientes de cuidados intensivos.
... Actualmente algunas investigaciones en EUA y Europa (26,32,34,35) han encontrado infecciones del torrente sanguíneo por C. albicans con incidencias de 51-70%. Otros autores han hallado especies no C. albicans representando la mayor incidencia (8,10,11,25,30,31,33,36,37), sin embargo, en algunas de esas casuísticas, C. albicans es la especie más frecuente del total de los episodios. Se debe re-saltar que estudios conducidos en Latino América incluyendo Brasil, México y Venezuela, especies no C. albicans se han aislado en 53 a 68% de los casos (8,10,11,30,31,36,37). ...
... Otros autores han hallado especies no C. albicans representando la mayor incidencia (8,10,11,25,30,31,33,36,37), sin embargo, en algunas de esas casuísticas, C. albicans es la especie más frecuente del total de los episodios. Se debe re-saltar que estudios conducidos en Latino América incluyendo Brasil, México y Venezuela, especies no C. albicans se han aislado en 53 a 68% de los casos (8,10,11,30,31,36,37). En la presente investigación C. albicans y espacies no C. albicans se aislaron en 10,26 y 89,74%, respectivamente. ...
... En los resultados de la literatura disponible, a nivel mundial la incidencia varía de 6-49% (7-11, 25, 30, 31, 33, 36-42). Es de hacer notar, que la incidencia puede variar por año dentro de la misma institución, en Italia (42) También estudios en otras áreas de Venezuela han encontrado un ascenso de C. parapsilosis de 6 a 48% (36,38), lo que indica un similar porcentaje a nuestros resultados y el incremento de esta especie en nuestro país en los últimos años. ...
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The epidemiology of candidemia in the Servicio Autónomo Hospital Universitario de Maracaibov(SAHUM) was studied. From January 2008 to March 2010, 78 candidemia episodes from 70 patients were analyzed. Ages ranged from 15 days to 80 years old. Patients were hospitalized in different wards at SAHUM. Candida spp was isolated in blood cultures processed at the Bacteriology Reference Center (CRB). For species identification, chromogenic Brilliance Candida Agar and Vitek-YBC were used. Additionally, the cultures were evaluated by traditional methods at the Mycology Laboratory, University of Zulia. Patients' characteristics were obtained from the CRB register. The median patients' age was 17 years old. Eight sequential isolates were obtained. The following Candida species were found:, C. parapsilosis 51.28%, C. tropicalis 15.38%, C. guilliermondii 11.54%, C. albicans 10.26%, C. famata 6.41%, C. glabrata 3.85% and Candida krusei 1.28%. X 2 showed that children in non-ICU wards were more likely to have candidemia. A change in the frequency of the species isolated was observed; for this reason, a permanent surveillance system is required.
... Actualmente algunas investigaciones en EUA y Europa (26,32,34,35) han encontrado infecciones del torrente sanguíneo por C. albicans con incidencias de 51-70%. Otros autores han hallado especies no C. albicans representando la mayor incidencia (8,10,11,25,30,31,33,36,37), sin embargo, en algunas de esas casuísticas, C. albicans es la especie más frecuente del total de los episodios. Se debe re-saltar que estudios conducidos en Latino América incluyendo Brasil, México y Venezuela, especies no C. albicans se han aislado en 53 a 68% de los casos (8,10,11,30,31,36,37). ...
... Otros autores han hallado especies no C. albicans representando la mayor incidencia (8,10,11,25,30,31,33,36,37), sin embargo, en algunas de esas casuísticas, C. albicans es la especie más frecuente del total de los episodios. Se debe re-saltar que estudios conducidos en Latino América incluyendo Brasil, México y Venezuela, especies no C. albicans se han aislado en 53 a 68% de los casos (8,10,11,30,31,36,37). En la presente investigación C. albicans y espacies no C. albicans se aislaron en 10,26 y 89,74%, respectivamente. ...
... En los resultados de la literatura disponible, a nivel mundial la incidencia varía de 6-49% (7-11, 25, 30, 31, 33, 36-42). Es de hacer notar, que la incidencia puede variar por año dentro de la misma institución, en Italia (42) También estudios en otras áreas de Venezuela han encontrado un ascenso de C. parapsilosis de 6 a 48% (36,38), lo que indica un similar porcentaje a nuestros resultados y el incremento de esta especie en nuestro país en los últimos años. ...
... La identificación molecular de estas especies es de suma importancia en nuestro país debido a la elevada frecuencia de aislamiento del CCP. Según un estudio de Dolande Franco et al. 8 , C. parapsilosis aislada del torrente sanguíneo ocupó el segundo lugar (26% de los aislamientos); por su parte, según Panizo et al. 17 , C. parapsilosis fue el agente más comúnmente aislado de episodios de candidemia (48,5%). Otros estudios sobre candidemia en Venezuela han publicado porcentajes variables (43-51%) de aislamientos de C. parapsilosis 5,7,15 . ...
... Existen en la literatura opiniones encontradas acerca de la utilidad para el laboratorio clínico de la discriminación molecular de las tres especies, basadas en las ligeras diferencias existentes en sus perfiles de sensibilidad a los antifúngicos 6,11 . Aunque las diferencias son sutiles, los datos obtenidos en este estudio evidencian que C. orthopsilosis y C. metapsilosis son más sensibles a AB y CS que C. parapsilosis; este hecho puede tener relevancia clínica e influir en las decisiones terapéuticas, sobre todo en nuestro país, según los estudios nacionales realizados 5,6,8,15,17 . La relevancia clínica de la resistencia cruzada entre los azoles ha sido informada en series de casos de candidemias. ...
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Background: Candida parapsilosis is a species complex consisting of Candida parapsilosis sensu stricto, Candida orthopsilosis, and Candida metapsilosis. Studies worldwide have described its epidemiology and susceptibility to antifungal agents. Aims: The aims of this study were to carry out the molecular identification of blood isolates belonging to the Candida parapsilosis species complex, and to determine their in vitro susceptibility to antifungals of systemic use. Methods: A study of 86 strains of C. parapsilosis species complex collected in 2008-2011 and obtained from the Candidaemia Surveillance Network of Mycology Department of the Rafael Rangel National Institute of Hygiene, was made. Secondary alcohol-dehydrogenase gene amplification was performed using polymerase chain reaction, and the products were analysed by restriction fragments length polymorphisms using the enzyme BanI. Susceptibility tests were performed using Etest(®), following the manufacturer's instructions with modifications. Results: Of the 86 isolates studied, 81 (94.2%) were C. parapsilosis sensu stricto, 4 (4.6%) C. orthopsilosis, and one (1.2%) C. metapsilosis. C. parapsilosis isolates were susceptible to amphotericin B and caspofungin, showing low rates of resistance to fluconazole and voriconazole. C. orthopsilosis and C. metapsilosis were susceptible to all the antifungals tested. Conclusions: The results obtained in Venezuela provide for the first time important information about the distribution of C. parapsilosis species complex in cases of candidaemia, and support the need for continuing surveillance programs, including molecular discrimination of species and antifungal susceptibility tests, which may guide specific therapy.
... En algunos casos, el Complejo C. parapsilosis ha superado a C. albicans como especie causal de candidemias, tal y como se ha reportado en algunos hospitales pediátricos, centros hospitalarios de tercer nivel, centros que atienden pacientes oncológicos y programas de vigilancia epidemiológica en diferentes regiones geográficas del mundo. Las infecciones del torrente sanguíneo causadas por este complejo tienen una tasa de mortalidad que oscila entre 4 a 45%, con un promedio de 28,5%, que se considera muy elevada [2,3,[5][6][7][10][11][12][13][14][15][16][17][18]. ...
... En nuestro país, Dolande y col [15], en un estudio piloto para evaluar el comportamiento de las especies de Candida provenientes de muestras clínicas en el área metropolitana de Caracas, reportaron que C. parapsilosis aislada del torrente sanguíneo ocupó el segundo lugar (26% de los aislamientos). Panizo et al [16], informaron que C. parapsilosis fue el agente más comúnmente aislado de episodios de candidemia (48,5%), seguido de C. tropicalis, C. albicans, C. pelliculosa, C. intermedia, C. glabrata y C. lusitaniae. ...
... Las enfermedades nombradas han sido reportadas en todo el país por varios autores, en orden de frecuencia destacan la paracoccidioidomicosis (37,1-49,4%), en pacientes que habitan áreas de los estados Carabobo y Monagas y en el Distrito Federal la histoplasmosis (32, 9- A pesar de que existe buena información disponible sobre las tasas de prevalencia e incidencia de estas enfermedades, y que se han explicado sus posibles causas (e.g., biológicas, conductuales, eco-epidemiológicas) (8,12,13), en Venezuela no se consideran las micosis enfermedades de denuncia obligatoria (2,3), pese a que estas son una importante causa de morbilidad en niños y adultos jóvenes, ocasionan discapacidad y complicaciones severas que pueden llevar a la muerte. Este planteamiento de micosis sistémicas como problema de salud pública en Venezuela, ha motivado la presente investigación sobre las cifras de mortalidad en los registros oficiales de la Dirección de Epidemiología y Análisis Estratégico (DEAE) del Ministerio de Sanidad y Desarrollo Social (17), atribuibles a las micosis sistémicas más importantes, específicamente, paracoccidioidomicosis, histoplasmosis, criptococosis, neumocistosis, coccidioidomicosis, candidiasis, zigomicosis, hialohifomicosis, lobomicosis y blastomicosis en pacientes sin VIH. ...
... El aumento de aislamientos de Candida no C. albicans, y cambios en la distribución de Candida spp. ha sido descrito, principal-mente en estudios realizados en América Latina (24)(25)(26)(27)(28)(29). En nuestro medio nosotros encontramos en datos publicados en 2010, que especies de Candida no albicans, aisladas de hemocultivos representaron 89,7% del total de levaduras del género Candida, con predominio de C. parapsilosis (19). ...
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To determine the susceptibility of Candida strains isolated from blood cultures in Maracaibo, Venezuela, 78 strains obtained from hospitalized patients in different services of the autonomous Maracaibo University Hospital, Venezuela, were studied. Chromogenic Medium Brilliance Candida Agar and Vitek-YBC were used for species identification. In addition, cultures were assessed using the traditional identification method. Susceptibility was determined by the diffusion method with fluconazole and voriconazole disks, according to the Clinical and Laboratory Standard Institute, Document M44-A2. Frequency of the Candida species was: C. parapsilosis 51.28%, C. tropicalis 15.38%, C. guilliermondii 11.54%, C. albicans 10.26% C. famata 6.41%, C. glabrata 3.85% and C. krusei 1.28%. Susceptibility was 96.15% and 100% for fluconazole and voriconazole, respectively. Three isolates identified as C. albicans, C. guilliermondii and C. krusei were resistant to fluconazole. These results suggest that fluconazole and voriconazole can be useful in the treatment of patients with candidemia; however, epidemiological surveillance and susceptibility pattern determination of Candida must be maintained.
... El aumento de aislamientos de Candida no C. albicans, y cambios en la distribución de Candida spp. ha sido descrito, principal-mente en estudios realizados en América Latina (24)(25)(26)(27)(28)(29). En nuestro medio nosotros encontramos en datos publicados en 2010, que especies de Candida no albicans, aisladas de hemocultivos representaron 89,7% del total de levaduras del género Candida, con predominio de C. parapsilosis (19). ...
Article
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To determine the susceptibility of Candida strains isolated from blood cultures in Maracaibo, Venezuela, 78 strains obtained from hospitalized patients in different services of the autonomous Maracaibo University Hospital, Venezuela, were studied. Chromogenic Medium Brilliance Candida Agar and Vitek-YBC were used for species identification. In addition, cultures were assessed using the traditional identification method. Susceptibility was determined by the diffusion method with fluconazole and voriconazole disks, according to the Clinical and Laboratory Standard Institute, Document M44-A2. Frequency of the Candida species was: C. parapsilosis 51.28%, C. tropicalis 15.38%, C. guilliermondii 11.54%, C. albicans 10.26% C. famata 6.41%, C. glabrata 3.85% and C. krusei 1.28%. Susceptibility was 96.15% and 100% for fluconazole and voriconazole, respectively. Three isolates identified as C. albicans, C. guilliermondii and C. krusei were resistant to fluconazole. These results suggest that fluconazole and voriconazole can be useful in the treatment of patients with candidemia; however, epidemiological surveillance and susceptibility pattern determination of Candida must be maintained. Resumen: Para determinar la susceptibilidad de cepas de Candida aisladas de hemocultivos en nuestro medio, se estudiaron 78 cepas obtenidas de pacientes hospitalizados en diferentes servicios del Servicio Autónomo Hospital Universitario de Maracaibo (SAHUM), Venezuela. Para la identificación de especies se usó el medio cromogénico Brilliance Candida Agar y Vitek-YBC. Adicionalmente, los cultivos fueron identificados por el método tradicional. La susceptibilidad fue determinada por el método de difusión con discos de fluconazol y voriconazol según la metodología M44-A2 del Clinical Laboratory Standard Institute. La frecuencia de las especies de Candida fue: C. parapsilosis 51,28%, C. tropicalis 15,38%, C. guilliermondii 11,54%, C. albicans 10,26% C. famata 6,41%, C. glabrata 3,85% y C. krusei 1,28%. La susceptibilidad fue de 96,15% y 100% para fluconazol y voriconazol, respectivamente. Tres de las 78 cepas, identificadas como C. albicans, C. guilliermondii y C. krusei fueron resistentes a fluconazol. Estos resultados sugieren que fluconazol y voriconazol pueden ser utilizados en el tratamiento de pacientes con candidemia en SAHUM, sin embargo, la vigilancia epidemiológica y la determinación de la susceptibilidad de Candida deben mantenerse.
... Also, all the studied strains were sensitive to amphotericin B and voriconazole. [35] Another study reveals that C. krusei and C. glabrata are poorly sensitive to fluconazole and the resistance increase is suggested to be a consequence of the frequent prophylactic use of fluconazole. [36] The association between non-albicans species has been observed in Japan in fluconazole-related candidemias. ...
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Onychomycosis of the fingernails and toenails is generally caused by dermatophytes and yeasts. Toenail mycoses involve mainly dermatophytes but when Candida is also involved, the strain most commonly isolated worldwide is C. albicans. To determine Candida strains prevailing in onychomycosis. A retrospective, observational and descriptive study of fungal cultures retrieved from the registry of the microbiology laboratory of the Pontificia Universidad Católica was performed. Specimens obtained from patients attending the healthcare network between December 2007 and December 2010 was analyzed. A descriptive statistical analysis was performed. Candida was retrieved from 467 of 8443 specimens (52% fingernails and 48% toenails). Cultures were negative in 5320 specimens (63.6%). Among Candida-positive cultures, parapsilosis was the most commonly isolated strain with 202 cases (43.3%). While isolates of Candida guillermondii were 113 (24.2%), those of Candida albicans were 110 (23.6%), those of spp. were 20 (4.3%) and there were 22 cases of other isolates (4.71%). Among the 467 patients with positive cultures for Candida, 136 (29,1%) were men and 331 (70,9%) were women. All patients were older than 18 years old. Clinical files were available for only 169 of the 467 patients with positive cultures for Candida. For those, age, gender, underlying illnesses and use of immunossupresive agents during the trial was reviewed. The present study shows that both C. parapsilosis as well as C. guillermondii appear as emerging pathogens that would be in fact taking the place of C. albicans as the most commonly isolated pathogen in patients with Candida onychomycosis. The relative percentage of C parapsilosis increases every year. Identification of Candida strains as etiological agents of nail candidiasis becomes relevant to the management both nail as well as systemic candidiasis, in view of the resistance to conventional treatments readily reported in the literature.
... For AMB, the breakpoint has not been defined, and the test range recommended by the CLSI is 0.03 to 16µg/ml. Studies show that the MICs of susceptible strains are no more than 1µg/ml, and it is unnecessary to use such a broad test range [7][8][9] . In conclusion, our study has provided additional information on an extremely relevant topic. ...
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Introduction: Amphotericin B (AMB) is an antifungal agent used extensively in clinical medicine, yet resistance remains low. This study aims to evaluate the susceptibility of Candida spp. against AMB. Methods: For broth microdilution susceptibility testing, 77 strains of Candida spp. were selected (32 C. albicans, 33 C. tropicalis, and 12 C. parapsilosis). The strains were considered susceptible when they exhibited MIC≤1.0µg/ml. Results: None of the strains showed an MIC greater than 0.25µg/ml. Conclusions: Further works are necessary, with a higher number of strains, to assess the validity of the results used in this study.
Article
Candida glabrata is the second frequent etiologic agent of mucosal and invasive candidiasis. Based on the recent developments in molecular methods, C. glabrata has been introduced as a complex composed of C. glabrata, Candida nivariensis, and Candida bracarensis. The four main classes of antifungal drugs effective against C. glabrata are pyrimidine analogs (flucytosine), azoles, echinocandins, and polyenes. Although the use of antifungal drugs is related to the predictable development of drug resistance, it is not clear why C. glabrata is able to rapidly resist against multiple antifungals in clinics. The enhanced incidence and antifungal resistance of C. glabrata and the high mortality and morbidity need more investigation regarding the resistance mechanisms and virulence associated with C. glabrata; additional progress concerning the drug resistance of C. glabrata has to be further prevented. The present review highlights the mechanism of resistance to antifungal drugs in C. glabrata.
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Aim: To determine the prevalence of candidemia in critically ill patients admitted to the Intensive Care Unit (ICU) of the "Servicio Autónomo Hospital Universitario de Maracaibo", Maracaibo, Zulia state, in the years 2010-2015. Methods: We setup a descriptive and applied research, with no experimental and retrospective design, in which be included all patients admitted to the ICU who were taken blood cultures and was detected Candida spp; we analyzed the species involved and its antifungal susceptibility. Results: The prevalence of candidemia was detected in 15.8% (n= 203/1282); finding a predominance of non-albicans species (67%), prevailing mainly C. haemulonii (23.6%), C. parapsilosis (17.2%) and C. famata (13.3%); while C. albicans was identified in 9.4% of cases. Most isolates (43.8%) proved to multisusceptible as polyene antifungal agents, azoles, flucytosine or cancinas equine, while 37.9% were resistant (p <0.05); while the main species isolated were those that showed higher percentages of resistance (C. famata 100%, 20.8% C. haemulonii and C. tropicalis 14.3%). Isolates were obtained from samples taken mainly through the central catheter that by venipuncture (65.5% vs. 34.5%; p> 0.05). Conclusion: There is a high prevalence of candidemia in critically ill patients, predominantly non-albicans species which showed higher percentages of resistance. Key Word: Candida spp, Candidemia, Blood cultures, Critically illnesses, Antifungal susceptibility.
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Recibido para publicación el 15 noviembre 2014. Aprobado para publicación el 8 diciembre 2014. rESUmEn: Las enfermedades fúngicas invasoras (EFIs) se presentan en la actualidad como un conjunto de afecciones causantes de una morbimortalidad de gran impacto en la medicina contemporánea. Estas EFIs son causadas por hongos levaduriformes como especies de Candida, además de otras levaduras de interés clínico y hongos filamentosos como especies de Aspergillus, entre otros. El conocimiento de estas especies de hongos causantes de EFIs, permitirán orientar el diagnóstico clínico preventivo, el tratamiento de las mismas y el incremento epidemiológico de cada centro de salud, el cual va a depender del tipo de pacientes con sus respectivas patologías clínicas. Palabras claves: Epidemiología, enfermedad fúngica invasora, hongos levaduriformes, hongos filamentosos. EPIDEMIOLOGY OF INVASIVE FUNGAL DISEASES SUmmArY Invasive fungal diseases (EFIs) are presented today as a set of conditions that cause a great impact on morbidity and mortality in contemporary medicine. These EFIs are caused by yeast such as Candida species, and other clinically relevant yeasts and filamentous fungi such as Aspergillus species, among others. Knowledge of these species of fungi causing EFIs, help guide preventive clinical diagnosis, treatment and epidemiological them increase each health center, which will depend on the type of patients with their clinical conditions. Introducción Los hongos son organismos eucariotas, unos se caracterizan por la formación de estructuras filamentosas y otros por presentar estructuras unicelulares como las levaduras, estas estructuras van a ser las formas invasivas patógenas para el humano produciendo alergias o infecciones fúngicas (1). En las últimas décadas las infecciones por micosis invasoras se han presentado como un importante problema de salud pública, bien sea de origen nosocomial o asociadas a cuidados sanitarios (2), en gran parte también por el aumento de la población en riesgo. Las enfermedades fúngicas invasoras (EFIs) están asociadas a elevadas tasas de morbilidad y mortalidad debido a lo dificultoso que es hacer un diagnóstico precoz, lo que conlleva a un retraso en la aplicación del tratamiento adecuado (3). Entre los pacientes susceptibles a desarrollar una EFI se encuentran los huéspedes inmunosuprimidos por quimioterapia, presencia de tumores sólidos, hematológicos con o sin ausencia de neutropenia y disfunción cualitativa de neutrófilos, receptores de trasplantes hematopoyéticos o de órganos sólidos, los que presentan disfunción en la inmunidad celular debido al uso prolongado de corticosteroides e inmunosupresores, infectados por VIH, cirugías de gran investidura, pacientes con enfermedades autoinmunes, los que reciben terapias biológicas, prematuros, en edad avanzada y críticamente enfermos (2,3,4). Esta diversidad en la inmunidad y los avances en la medicina ha conllevado a cambios significativos en la epidemiología de las infecciones por hongos y en la utilización de los antifúngicos para la prevención y tratamiento empírico de estas micosis (5). Las EFIs más frecuentes en estos pacientes es la causada por Candida spp., que a veces es clínicamente indistinguible de la septicemia bacteriana, seguida aunque en menor frecuencia de micosis respiratorias o diseminadas causadas por hongos filamentosos como Aspergillus, Scedosporium, Fusarium, Acremonium, Zigomicetos y Pneumocystis, y hongos pertenecientes a la división Zygomycota. También se encuentra involucrado Pneoumocystis jirovecii (6). En la actualidad la candidiasis invasora es la cuarta causa de infección nosocomial en los EE.UU y Europa, además de ser el ARTÍCULO DE REVISIÓN
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SUMMARY Prevalence of Candida albicans and Candida no albicans in clinical samples during 1999-2001. The importance of epidemiological monitoring of yeasts involved in pathologic processes is unquestionable due to the increase of these infections over the last decade, the changes observed in species causing candidiasis, and empirical antifungal treatment. At the Mycology Center, 1006 isolates from a wide range of clinical samples were studied during 1999-2001. Candida albicans (40.3%) was the most isolated species, although, the Candida no albicans species with 54.9% showed the major prevalence. In blood cultures Candida parapsilosis (34.9%), C. albicans (30.2%) and C. tropicalis (25.6%) were recovered most frequently while C. glabrata represented only 2.3%. C. albicans with 60%-80% was the predominant specie in mucosal surface. We also detected Candida mediastinistis, which alert us over the importance at this location. Urinary tract infections caused by yeasts were more frequent in hospitalized patients, being C. albicans (47.7%), the most commonly isolated, followed by C. glabrata (24.8%) and C. tropicalis (20.0%). In the candidal onychomycoses, C. parapsilosis (37.7%) outplaced C. albicans (22.0%). Fluconazole susceptibility studies of Candida species allowed us to conclude that the majority of C. albicans islolates are susceptible, and that the highest resistance averages were observed in C. glabrata (21.41%) and C. krusei (69.23%).
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The phenotypic characterization and the distribution of Candida spp. isolates coming from 92 patients with Candidemia (adults and children) that were hospitalized in the ICU and non ICU Services at The University Hospital of Maracaibo, Zulia State, Venezuela, from March 2000 to September 2002, was the aim of this study. Hemocultures isolated yeasts identification were done using CHROMagar Candida and traditional methods; in some cases were applied API 20C and ID32. The results showed the presence of Candida albicans (33,7%) and Candida non albicans (66,3%): Candida tropicalis (30,4%), Candida parapsilosis (21,7%), Candida guilliermondii (5,4%), Candida pelliculosa (5,4%), Candida famata (2,2%) and Candida glabrata (1,1%). The isolates from children (n=70) located in ICU and non ICU services showed predominance of C. parapsilosis and C. albicans respectively. On the other hand, C. tropicalis was the most frequent isolate in both adult services. The predominance of Candida non albicans observed in this study has been reported in Latin American countries
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Dirección para correspondencia: Las infecciones fúngicas nosocomiales han sido una importante causa de morbimortalidad en los hospita-les terciarios durante la última década, tanto por el aumen-to de su incidencia como por la dificultad de su diagnóstico precoz. El aumento de su incidencia es debi-do, entre otras causas, a la mayor supervivencia de los pacientes inmunodeprimidos, a la eclosión de los trasplan-tes de órganos, al frecuente empleo de dispositivos endo-vasculares, antibióticos de amplio espectro o tratamientos inmunosupresores. En definitiva, su incidencia es paralela al número de enfermos con algún grado de inmunosupre-sión, considerándose una infección inherente al progreso médico. La gran mayoría de las infecciones fúngicas noso-comiales en nuestro medio son debidas a levaduras, cons-tituyendo una importante causa de sepsis nosocomial. En esta revisión se detallan las principales características epi-demiológicas de estas infecciones, sus factores de riesgo habitualmente observados, los patrones de sensibilidad de las especies causales así como el pronóstico y evolución de las mismas. INFECCIÓN NOSOCOMIAL POR LEVADURAS DEL GÉNERO CANDIDA Incidencia. La incidencia global de las infecciones nosocomiales ha aumentado en la mayoría de los hospita-les, pero, en los últimos años, las producidas por Candida spp. han presentado un incremento mucho mayor, siendo la candidemia la forma de infección nosocomial por leva-duras más frecuente en nuestro medio. Sin embargo, su tasa de incidencia global es difícil de precisar puesto que depende del grado de especialización del hospital. En los hospitales terciarios el incremento de su incidencia, com-parada con la observada en la década de 1980, es superior al 500%; pero en los hospitales comarcales, es considera-blemente inferior (75%) [1]. No obstante, la incidencia está aumentando globalmente en todos los hospitales y en todas las unidades, estimándose que el 5% de los pacien-tes hospitalizados desarrolla una infección nosocomial y de éstas el 5% son debidas a alguna especie de Candida. En España, según el estudio multicéntrico Sepsis Data realizado entre 1994 y 1997 y en el que participaron 24 hospitales, las infecciones fúngicas representan el 3,1% de todas las sepsis, siendo Candida spp. el octavo agente causante de infección sistémica. Según este estudio, el 72,1% de los casos de fungemia fue de origen nosocomial, con una tasa de mortalidad del 33,3% [2]. En Estados Unidos, Candida spp. es el cuarto microorganismo más frecuentemente aislado en las sepsis, produce el 8% de las mismas, con una tasa de mortalidad del 38% [3]; en este país, el 85,6% de las micosis nosocomiales son debidas al género Candida.
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El desarrollo de métodos fiables para la detección de resistencia in vitro junto con el aumento de micosis por cepas o especies fúngicas que presentan resis-tencia intrínseca o secundaria a los antifúngicos, han hecho aumentar la impor-tancia clínica de los estudios de sensibilidad a los antifúngicos. La cuestión que muchos expertos se plantean en la actualidad es si pueden basarse las indica-ciones de los diferentes antifúngicos, en los resultados obtenidos con los estu-dios de sensibilidad disponibles. En este artículo se analizan la fiabilidad de las pruebas de detección de resistencias in vitro, su correlación con el fracaso tera-péutico y, por último, la utilidad real de los estudios de sensibilidad a los antifún-gicos. Antifúngicos, Estudios de sensibilidad, Utilidad clínica Should antifungal treatments be based upon results of antifungal susceptibility testing? The development of reliable procedures for detecting resistance in vitro to anti-fungal agents and the increase in the prevalence of mycoses due to organisms with intrinsic or secondary resistance have reinforced the clinical relevance of antifungal susceptibility testing. A matter is currently in the limelight: can antifun-gal agents indications be based on susceptibility testing results? The present paper reviews the reliability of susceptibility testing procedures available at the moment, their capability for predicting therapeutic failure, and their clinical useful-ness.
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The performance of the Etest for fluconazole susceptibility testing of 402 yeast isolates was assessed against the National Committee for Clinical Laboratory Standards (NCCLS) microdilution broth method. The NCCLS method employed RPMI 1640 broth medium, and MICs were read after incubation for 48 h at 35 degrees C. Etest MICs were determined with RPMI agar containing 2% glucose (RPG), Casitone agar (CAS), and Mueller-Hinton agar (MHA) and were read after incubation for 48 h at 35 degrees C. The yeast isolates included Candida albicans (n = 161), Candida glabrata (n = 41), Candida tropicalis (n = 35), Candida parapsilosis (n = 29), Candida krusei (n = 32), Candida lusitaniae (n = 31), Candida species (n = 19), Cryptococcus neoformans (n = 40), and miscellaneous yeast species (n = 14). The Etest results correlated well with reference MICs. Overall agreement was 94% with RPG, 97% with CAS, and 53% with MHA. When RPG was used, agreement ranged from 89% for Candida spp. to 100% for C. krusei. When CAS was utilized, agreement ranged from 93% for Cryptococcus neoformans to 100% for C. tropicalis, C. parapsilosis, C. lusitaniae, Candida spp., and miscellaneous yeast species. With MHA, agreement ranged from 17% for C. parapsilosis to 90% for C. krusei. Both RPG and CAS supported growth of all yeast species, whereas growth on MHA was comparatively weaker. Etest results were somewhat easier to read on CAS. The Etest method using either RPG or CAS, but not MHA, appears to be a viable alternative to the NCCLS reference method for determining fluconazole susceptibilities of yeasts.
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During a 2-year surveillance program (1996 to 1998) in Quebec, Canada, 442 strains of Candida species were isolated from 415 patients in 51 hospitals. The distribution of species was as follows: Candida albicans, 54%; C. glabrata, 15%; C. parapsilosis, 12%; C. tropicalis, 9%; C. lusitaniae, 3%; C. krusei, 3%; and Candida spp., 3%. These data, compared to those of a 1985 survey, indicate variations in species distribution, with the proportions of C. glabrata andC. parapsilosis increasing by 9 and 4%, respectively, and those of C. albicans and C. tropicalis decreasing by 10 and 7%, respectively. However, these differences are statistically significant for C. glabrata and C. tropicalis only. MICs of amphotericin B were ≥4 μg/ml for 3% of isolates, all of which were non-C. albicans species. Three percent of C. albicans isolates were resistant to flucytosine (≥32 μg/ml). Resistance to itraconazole (≥1 μg/ml) and fluconazole (≥64 μg/ml) was observed, respectively, in 1 and 1% of C. albicans, 14 and 9% of C. glabrata, 5 and 0% of C. tropicalis, and 0% of C. parapsilosis andC. lusitaniae isolates. Clinical data were obtained for 343 patients. The overall crude mortality rate was 38%, reflecting the multiple serious underlying illnesses found in these patients. Bloodstream infections were documented for 249 patients (73%). Overall, systemic triazoles had been administered to 10% of patients before the onset of candidiasis. The frequency of isolation of non-C. albicans species was significantly higher in this group of patients. Overall, only two C. albicans isolates were found to be resistant to fluconazole. These were obtained from an AIDS patient and a leukemia patient, both of whom had a history of previous exposure to fluconazole. At present, it appears that resistance to fluconazole in Quebec is rare and is restricted to patients with prior prolonged azole treatment.
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From March 1999 to March 2000, we conducted a prospective multicenter study of candidemia involving five tertiary care hospitals from four countries in Latin America. Yeast isolates were identified by classical methods and the antifungal susceptibility profile was determined according to the National Committee for Clinical Laboratory Standards microbroth assay method. During a 12 month-period we were able to collect a total of 103 bloodstream isolates of Candida spp. C. albicans was the most frequently isolated species accounting for 42% of all isolates. Non-albicans Candida species strains accounted for 58% of all episodes of candidemia and were mostly represented by C. tropicalis (24.2%) and C. parapsilosis (21.3%). It is noteworthy that we were able to identify two cases of C. lusitaniae from different institutions. In our casuistic, non-albicans Candida species isolates related to candidemic episodes were susceptible to fluconazole. Continuously surveillance programs are needed in order to identify possible changes in the species distribution and antifungal susceptibility patterns of yeasts that may occurs after increasing the use of azoles in Latin American hospitals.
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During the first year of an ongoing surveillance program of invasive fungal infections (IFI) a total of 130 patients (56% male) with fungal strains isolated from blood and other sterile sites were reported from 13 hospitals in Chile. Significant yeast isolates were obtained from 118 patients, and molds affected 12 patients. The main patient groups affected were neonates, children less than 1 year old and adults aged 50-79 years. All fungal bloodstream infections (BSI) were due to yeasts; 79 patients (61%) were affected. The main risk factors recorded were antibiotic therapy (76%), stay in the intensive care unit (ICU) (70%) and presence of a central venous catheter (65%). Nosocomial infections were represented in 83.5% of BSI. Overall, Candida albicans (40.8%), C. parapsilosis (13.1%), C. tropicalis (10%) and Cryptococcus neoformans (10%) were the most common species. Aspergillus fumigatus (3.1%) was the most frequent mold. C. albicans (48.1%) and C. parapsilosis (17.7%), were the most frequent agents recovered from blood. Saccharomyces cerevisiae and Trichosporon mucoides, two emerging pathogens, were also isolated. All yeasts tested were susceptible to amphotericin B with minimal inhibitory concentration (MIC) < or = 1 microg/ml. Resistance to itraconazole (MIC > or = 1 microg/ml) and fluconazole (MIC > or = 64 microg/ml) was observed in 4 and 6% of cases, respectively. C. glabrata was the least susceptible species, with 50% of isolates resistant to itraconazole and 33% resistant to fluconazole, with one strain showing combined resistance. Reduction of BSI requires greater adherence to hand-washing and related infection control guidelines.
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Recent studies have shown differences in the epidemiology of invasive infections caused by Candida species worldwide. In the period comprising August 2002 to August 2003, we performed a study in Santa Casa Complexo Hospitalar, Brazil, to determine Candida species distribution associated with candidemia and their antifungal susceptibility profiles to amphotericin B, fluconazole and itraconazole. Antifungal susceptibility was tested according to the broth microdilution method described in the NCCLS (M27A-2 method). Only one sample from each patient was analyzed (the first isolate). Most of the episodes had been caused by species other than C. albicans (51.6%), including C. parapsilosis (25.8%), C. tropicalis (13.3%), C. glabrata (3.3%), C. krusei (1.7%), and others (7.5%). Dose-dependent susceptibility to itraconazole was observed in 14.2% of strains, and dose-dependent susceptibility to fluconazole was found in 1.6%. Antifungal resistance was not found, probably related to low use of fluconazole. Further epidemiological surveillance is needed.
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Invasive Candida spp. infections in non-neutropenic critically ill patients admitted to intensive care units can be classified as focal and systemic. Both types of infection usually occur after episodes of candidemia, although some focal infections may be of exogenous development, like those occurring after trauma or be device-related. The clinical spectrum of invasive Candida spp. infections includes focal urinary tract, abdominal, ocular, respiratory tract, renal and hepato-biliary infections, as well as systemic infections like candidemia and acute systemic candidiasis with multiorgan involvement after hematogenous seeding. Candida spp. isolates in “significant” samples, like synovial fluid, cerebrospinal fluid and blood cultures, represent true infection. However, the diagnosis of invasive infection based on “non-significant” samples, like surgical drains and digestive tract exudates, requires additional criteria. The total number of isolates from different sites, the presence of risk factors, the clinical host response, as well as severity of illness need to be taken into account for the diagnosis of invasive candidiasis. The clinical signs of systemic infection due to Candida spp. are completely nonspecific and cannot be differentiated from bacterial peritonitis, urinary tract infection or bacteriemia. These infections may be associated with signs of sepsis, severe sepsis, septic shock or multiorgan dysfunction. In the future clinical multicentre observational and interventional studies are necessary to reach agreement on clinical definitions and classification of invasive Candida spp. infections in critically ill non-immunocompromised patients.
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Invasive candidiasis (IC) is the most frequent fungal infection in high risk patients in intensive care setting. IC is associated with high attributable mortality and increased healthcare cost. In this review current, epidemiological, diagnostic and clinical management is updated and discussed in the critically ill non neutropenic patient.
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During the last decades there has been an important increase in the incidence of fungal infections. These infections are common in the setting of Intensive Care Units (ICU), where the prevalence of high-risk patients is important. In this review we discuss the incidence of candidemia in ICUs, as well as the mortality and economic impact. The participation of non-Candida albicans Candida species in the etiology of these infections is currently increasing.
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More than 25,000 primary bloodstream infections (BSIs) were identified by 124 National Nosocomial Infections Surveillance System hospitals performing hospital-wide surveillance during the 10-year period 1980–1989. These hospitals reported 6,729 hospital-months of data, during which time approximately 9 million patients were discharged. BSI rates by hospital stratum (based on bed size and teaching affiliation) and pathogen groups were calculated. In 1989, the overall BSI rates for small (<200 beds) nonteaching, large nonteaching, small (<500 beds) teaching, and large teaching hospitals were 1.3, 2.5, 3.8, and 6.5 BSIs per 1,000 discharges, respectively. Over the period 1980–1989, significant increases (p < 0.0001) were observed within each hospital stratum, in the overall BSI rate and the BSI rate due to each of the following pathogen groups: coagulase-negative staphylococci, Staphylococcus aureus, enterococci, and Candida species. In contrast, the BSI rate due to gram-negative bacilli remained stable over the decade, in all strata. Except for small nonteaching hospitals, the greatest increase in BSI rates was observed in coagulase-negative staphylococci (the percentage increase ranged between 424% and 754%), followed by Candida species (219–487%). In small nonteaching hospitals, the greatest increase was for S. aureus (283%), followed by enterococci (169%) and coagulase-negative staphylococci (161%). Our analysis documents the emergence over the last decade of coagulase-negative staphylococci as one of the most frequently occurring pathogens in BSI.
Article
More than 25,000 primary bloodstream infections (BSIs) were identified by 124 National Nosocomial Infections Surveillance System hospitals performing hospital-wide surveillance during the 10-year period 1980-1989. These hospitals reported 6,729 hospital-months of data, during which time approximately 9 million patients were discharged. BSI rates by hospital stratum (based on bed size and teaching affiliation) and pathogen groups were calculated. In 1989, the overall BSI rates for small (less than 200 beds) nonteaching, large nonteaching, small (less than 500 beds) teaching, and large teaching hospitals were 1.3, 2.5, 3.8, and 6.5 BSIs per 1,000 discharges, respectively. Over the period 1980-1989, significant increases (p less than 0.0001) were observed within each hospital stratum, in the overall BSI rate and the BSI rate due to each of the following pathogen groups: coagulase-negative staphylococci, Staphylococcus aureus, enterococci, and Candida species. In contrast, the BSI rate due to gram-negative bacilli remained stable over the decade, in all strata. Except for small nonteaching hospitals, the greatest increase in BSI rates was observed in coagulase-negative staphylococci (the percentage increase ranged between 424% and 754%), followed by Candida species (219-487%). In small nonteaching hospitals, the greatest increase was for S. aureus (283%), followed by enterococci (169%) and coagulase-negative staphylococci (161%). Our analysis documents the emergence over the last decade of coagulase-negative staphylococci as one of the most frequently occurring pathogens in BSI.
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The administration of fluconazole in intensive care unit (ICU) patients leads to the emergence of bacterial and fungal resistance. Retrospective analysis of 2 patient cohorts: (1) critically ill patients treated in surgical, trauma, and medical ICUs between June 1997 and January 1999 who did and did not receive fluconazole; and (2) ICU patients with fungal infections and sensitivity testing results from June 1994 to December 1998. University-affiliated tertiary care hospital. The first cohort included 99 ICU patients with documented microorganism culture(s) who were treated with (n = 50) or without (n = 49) fluconazole; the second cohort included 38 patients with Candida species infection, identification, and antifungal susceptibility testing. Mortality (40% vs 20%; P = .03) and hospital length of stay (33.8 vs 25.6 days; P = .04) were higher in the patients treated with fluconazole compared with patients not treated with fluconazole. The ICU length of stay was also higher in patients treated with fluconazole (23.7 vs 15.1 days; P = .009). An increase in bacterial resistance occurred in patients after fluconazole treatment as opposed to bacterial resistance of patients who were treated for bacterial microorganism(s) without fluconazole (16% vs 4%; P = .049). Comparison of patient populations with Candida species identification before and after December 1997 showed an increase in Candida species resistance to fluconazole (11% vs 36%; P = .16), respectively. Fungal strains were dominated by a combination of Candida albicans and Candida glabrata in both populations (60% [before 1998] vs 82% [after 1998]), with an emergence of Candida non-albicans species tolerant to fluconazole. The amount of fluconazole administered and the number of patients receiving fluconazole treatment in the ICUs has also increased when comparing both periods. Comparison of critically ill patient populations with and without fluconazole treatment found increased mortality and longer hospital and ICU lengths of stay in the fluconazole-treated group. This group also had higher bacterial pathogen resistance to antibiotics after fluconazole administration compared with bacterial resistance of patients without fluconazole treatment. Our results warrant concern regarding worsening bacterial infections, increased mortality, and an increase in Candida resistance to fluconazole from increased use in ICU patients, with a shift in yeast infection that is more difficult to treat.
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To determine whether our practice of requesting an autopsy for patients who die in the medical intensive care unit (MICU) continues to be a valid approach to obtain clinically and educationally relevant findings. In this retrospective study conducted in an adult MICU population of a university hospital, the clinical diagnoses and postmortem major diagnoses of 100 patients who died in 1996 (autopsy rate of 93%) were compared. Eighty-one percent of the clinical diagnoses were confirmed at autopsy. In 16%, autopsy findings revealed a major diagnosis that, if known before death, might have led to a change in therapy and prolonged survival (class I missed major diagnoses). The most frequent class I missed major diagnoses were fungal infection, cardiac tamponade, abdominal hemorrhage, and myocardial infarction. Another 10% of autopsies revealed a diagnosis that, if known before death, would probably not have led to a change in therapy (class II error). Autopsy remains an important tool for education and quality control. In contrast with historical series of 1 to 2 decades ago, there is a clear shift in the type of class I missed major diagnoses toward opportunistic infections. Bedside-applicable techniques such as electrocardiography with supplemental posterior leads, echocardiography, and meticulous abdominal ultrasonography might improve the outcome in selected MICU patients.
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We describe the annual incidence of primary bloodstream infection (BSI) associated with Candida albicans and common non-albicans species of Candida among patients in intensive care units that participated in the National Nosocomial Infections Surveillance system from 1 January 1989 through 31 December 1999. During the study period, there was a significant decrease in the incidence of C. albicans BSI (P < .001) and a significant increase in the incidence of Candida glabrata BSI (P = .05).
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The results of the epidemiological study on candidemias with the highest number of cases carried out in Spain is presented. This study is included in the Epidemiological Survey of Candidemia in Europe supported by the ECMM in which another five countries take part. In the Spanish study, 19 hospitals participated, 290 candidemia episodes were analysed (80 in children under 15 years and 210 in adults), 293 strains of yeasts being isolated. Both in children and in adults, the risks factors more frequently observed were the intravenous catheter and previous antibiotic therapy. In adults, the most habitual underlying disease was the solid tumor and, in children, hematological diseases. Candida albicans was the most prevalent species isolated in adults (46.1%) and Candida parapsilosis in children (50%). As part of the therapy, the intravenous line was removed and antifungal treatment was prescribed to 74% and 92.5% of children, respectively and to 43.8% and 73.8% of adults. The antifungal agent of election in adults was fluconazole (54.8%) and liposomal amphotericin B (58.1%) in children. The global mortality of the study was 38.9%, which for ages was major in adults (41.4%) than in children (38.7%). The geographical distribution of the isolated species was homogeneous, C. albicans being the predominant species, with the exception of Galicia and Extremadura where C. parapsilosis was the most frequent.
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The development of reliable procedures for detecting resistance in vitro to antifungal agents and the increase in the prevalence of mycoses due to organisms with intrinsic or secondary resistance have reinforced the clinical relevance of antifungal susceptibility testing. A matter is currently in the limelight: can antifungal agents indications be based on susceptibility testing results? The present paper reviews the reliability of susceptibility testing procedures available at the moment, their capability for predicting therapeutic failure, and their clinical usefulness.
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The correct identification of the microrganism is the base for epidemiological studies and treatment of infections. The aim of our study was to evaluate the efficacy of the chromogenic media Albicans ID (bioMerieux, France) in the identification of Candida albicans. A total of 190 yeasts strains were evaluated in the study. A rate of 100% of all C. albicans (80) and Candida dubliniensis (five) strains exhibited blue color. Nevertheless, the blue color was also observed with cultures of Candida rugosa (3/5) and Candida tropicalis (3/17). Albicans ID cromogenic media presented specificity rate of 90% and positive and negative predictive values of 88% and 100%, respectively, in the identification of C. albicans.
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During the last decades there has been an important increase in the incidence of fungal infections. These infections are common in the setting of Intensive Care Units (ICU), where the prevalence of high-risk patients is important. In this review we discuss the incidence of candidemia in ICUs, as well as the mortality and economic impact. The participation of non-Candida albicans Candida species in the etiology of these infections is currently increasing.
Article
Invasive candidiasis is the most prevalent fungal infection in the critical non neutropenic patient (80%) and is associated with high morbidity-mortality. Microbiological diagnosis is difficult and the positivity of traditional tests appears late in the course of infection. We herein discuss the utility of direct examination and cultures from different sites and the value of surveillance cultures for establishing the likelihood of invasive candidiasis.
Article
During 2003, a total of 1,397 Candida isolates, 73 Aspergillus isolates, 53 Cryptococcus neoformans isolates, and 25 other fungal isolates from infected, normally sterile, body sites in patients hospitalized in North America, Europe, and Latin America were studied as a component of the longitudinal SENTRY Antimicrobial Surveillance Program. The MICs for seven antifungal agents were determined in a central laboratory (JMI Laboratories, North Liberty, IA) using testing methods promulgated by the Clinical and Laboratory Standards Institute (formerly the National Committee for Clinical Laboratory Standards). The rank order of Candida spp. occurrence was as follows: C. albicans (48.7%), C. parapsilosis (17.3%), C. glabrata (17.2%), C. tropicalis (10.9%), C. krusei (1.9%), and other Candida spp. (4.0%). C. albicans accounted for 51.5, 47.8, and 36.5% of candidal infections in North America, Europe, and Latin America, respectively. Ravuconazole, voriconazole, and fluconazole were highly active against C. albicans, C. parapsilosis, and C. tropicalis, with both former agents being more potent (MIC at which 90% of the isolates tested are inhibited [MIC90] of ≤0.008 to 0.12 μg/ml) than fluconazole (MIC90 of 0.5 to 2 μg/ml). C. glabrata isolates were less susceptible to these agents, with MIC90s of 1, 1, and 64 μg/ml, respectively. Ravuconazole and voriconazole were the most active agents tested against C. krusei (MIC90 of 0.5 μg/ml). Among Aspergillus spp., A. fumigatus was the most commonly (71.2% of isolates) recovered species; 96.2, 96.2, 84.6, and 11.5% of strains were inhibited by ≤1 μg/ml of ravuconazole, voriconazole, itraconazole, and amphotericin B, respectively. Of the antifungal agents tested, ravuconazole and voriconazole displayed the greatest spectrum of activity against pathogenic Candida and Aspergillus spp., regardless of geographic origin. These results extend upon previous findings from SENTRY Program reports (1997 to 2000), further characterizing species composition as seen in local clinical practice and demonstrating the potent activity of selected, newer triazole antifungal agents.
Article
The high morbidity, mortality, and healthcare costs associated with the invasive fungal infections, especially in the critical care setting, is of importance since the prophylactic, empiric, and pre-emptive therapy interventions, based on early identification of risk factors, is of common occurrence. In the last years alone there have been important developments in antifungal pharmacotherapy. Evidence-based studies using new antifungal agents are now emerging as important players in the pharmacotherapy of invasive fungal infections in seriously ill and difficult patients. However, data on critically ill patients are more limited and usually recovered from general studies. This study shows the benefits obtained by the new antifungal agents on different clinical situations in critical care units. The increasing number of non-C. albicans species and the high mortality rates in these settings suggest that the application of early de-escalation therapy in critically ill patients with fungal infection should be mandatory. The possibility of using antifungal combination therapy in these types of patients should be considered.
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Department of Health, Education and Welfare -Centre for Diseases Control, 1978. 13. Lodder J. The Yeasts: A taxonomic Study
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National Committee for Clinical Laboratory Standards -Reference method for broth dilution antifungal susceptibility testing of yeasts
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Aspectos epidemiológicos de las infecciones del torrente sanguíneo por levaduras. Confrontando nuestra realidad con el mundo
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