Abstract
Systemic candidiasis are high mortality infections caused by yeasts of the genus Candida, affecting patients with numerous risk factors. Nowadays, candidemia produced by “non-albicans” species has increased considerably. Timely diagnosis and subsequent treatment substantially improve patients' survival. Our objectives are to study the frequency, distribution, and antifungal susceptibility profiles of candidemia isolates in our hospital. We conducted a descriptive, cross-sectional study. Positive blood cultures were recorded from January 2018 to December 2021. Positive Candida genus blood cultures were selected, classified, and analyzed on their susceptibility profile for amphotericin B, fluconazole and caspofungin using AST-YS08® card for VITEK 2 Compact® to determine minimum inhibitory concentration (MIC) and CLSI M60 2020 2nd Edition to determine breakpoints. 3862 positive blood cultures were obtained, 113 (2.93%) presented growth of Candida spp., corresponding to 58 patients. 55.2% came from the Hospitalization Ward and Emergency Services and 44.8% from the Intensive Care Unit. The species were distributed as follows: Nakaseomyces glabratus (Candida glabrata) (32.74%), Candida albicans (27.43%), Candida parapsilosis (23.01%), Candida tropicalis (7.08%) and others (9.73%). Most species were found to be susceptible to most antifungals, except for C. parapsilosis, presenting 4 isolates with resistance to fluconazole and N. glabratus (C. glabrata), whose clinical susceptibility data remains insufficient to provide accurate breakpoints. The percentage of recorded positive blood cultures of Candida spp. was 2.93%, these results were consistent with those reported at a regional level. A predominance of "non-albicans" species was observed. It is essential to know the prevalence, epidemiology, and susceptibility profiles of candidemia in our country, as well as being updated on its subsequent changes, maintaining epidemiological surveillance. This allows professionals to map out early and effective therapeutic strategies, staying alert of possible multi-resistant strains.
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References
Pappas PG, Lionakis MS, Arendrup MC, Ostrosky-Zeichner L, Kullberg BJ. Invasive candidiasis. Nat Rev Dis Primers. 2018. https://doi.org/10.1038/nrdp.2018.26.
McCarty TP, White CM, Pappas PG. Candidemia and invasive candidiasis. Infect Dis Clin N Am. 2021;35:389–413. https://doi.org/10.1016/j.idc.2021.03.007.
Lazo V, Hernández G, Méndez R. Candidiasis sistémica en pacientes críticos, factores predictores de riesgo. Horiz Méd. 2018;18:75–85.
Boonsilp S, Homkaew A, Phumisantiphong U, Nutalai D, Wongsuk T. Species distribution, antifungal susceptibility, and molecular epidemiology of Candida species causing Candidemia in a tertiary care Hospital in Bangkok Thailand. J Fungi. 2021. https://doi.org/10.3390/jof7070577.
Márquez F, Iturrieta I, Calvo M, Urrutia M, Godoy P. Artículo original investigación clínica epidemiología y susceptibilidad antifúngica de especies causantes de candidemia en la ciudad de Valdivia Chile. Rev Chilena Infectol. 2017. https://doi.org/10.4067/S0716-10182017000500441.
Tortorano AM, Prigitano A, Morroni G, Brescini L, Barchiesi F. Candidemia: evolution of drug resistance and novel therapeutic approaches. Infect Drug Resist. 2021;14:5543–53.
Aguilar G, Araujo P, Lird G, Insaurralde S, Kawabata A, Ayala E, et al. Identification and susceptibility profile of Candida species isolated from hemocultures in hospitals in Paraguay. Rev Panam Salud Publica. 2020. https://doi.org/10.26633/RPSP.2020.34.
Zurita MS. Situation of anti-fungal resistance of species of the genus Candida in Peru. Rev Peru Med Exp Salud Publica. 2018;35(1):126–31.
Calvo B, Melo ASA, Perozo-Mena A, Hernandez M, Francisco EC, Hagen F, et al. First report of candida auris in America: clinical and microbiological aspects of 18 episodes of candidemia. J Infect. 2016;73(4):369–74.
de Almeida JN, Francisco EC, Hagen F, Brandão IB, Pereira FM, Presta Dias PH, et al. Emergence of candida auris in Brazil in a covid-19 intensive care unit. J Fungi. 2021;7:741–963.
Adams E, Quinn M, Tsay S, Poirot E, Chaturvedi S, Southwick K, et al. Candida auris in healthcare facilities, New York, USA, 2013–2017. Emerg Infect Dis. 2018;24(10):1816–24.
Schelenz S, Hagen F, Rhodes JL, Abdolrasouli A, Chowdhary A, Hall A, et al. First hospital outbreak of the globally emerging Candida auris in a European hospital. Antimicrob Resist Infect Control. 2016. https://doi.org/10.1186/s13756-016-0132-5.
Losnak DO, Rocha FR, Almeida BS, Batista KZS, Althoff SL, Haupt J, et al. Molecular detection of fungi of public health importance in wild animals from Southern Brazil. Mycoses. 2018;61(7):455–63.
Arriola A, Arbo A. Factores de riesgo potenciales en infecciones sistémicas por Candida sp. Rev Inst Med Trop. 2020;15(2):5–12.
Cortés JA, Ruiz JF, Melgarejo-Moreno LN, Lemos EV. Candidemia in Colombia. Biomedica. 2020;40(1):195–207.
Bassetti M, Garnacho-Montero J, Calandra T, Kullberg B, Dimopoulos G, Azoulay E, et al. Intensive care medicine research a on invasive fungal infection in critically ill patients. Intensive Care Med. 2017;43(9):1225–38.
Ostrosky-Zeichner L, Sable C, Sobel J, Alexander BD, Donowitz G, Kan V, et al. Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting. Eur J Clin Microbiol Infect Dis. 2007;26(4):271–6.
León C, Ruiz-Santana S, Saavedra P, Almirante B, Nolla-Salas J, Álvarez-Lerma F, et al. A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med. 2006;34(3):730–7.
Pemán J, Zaragoza R. Hacia el diagnóstico temprano de la candidiasis invasora en el paciente crítico. Rev Iberoam Micol. 2012;29:71–5.
Ballesté R, Seija V, Anzalone L, Bazet C, Blanco J, Salvatella J. Manual de toma de muestras para estudio bacteriológico, parasitológico y micológico. Montevideo: Departamento de Laboratorio Clínico, Hospital de Clínicas; 2004
Antinori S, Milazzo L, Sollima S, Galli M, Corbellino M. Candidemia and invasive candidiasis in adults: a narrative review. Eur J Intern Med. 2016;34:21–8.
Macedo-Viñas M, Denning DW. Estimating the burden of serious fungal infections in Uruguay. J Fungi. 2018. https://doi.org/10.3390/jof4010037.
Rossell P, Decia M, Telechea H, Fernández N, Menchaca A. Incidencia y etiología de la candidiasis invasiva en la Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell. Arch Pediatría Urug. 2017;88(2):72–7.
Clinical and Laboratory Standards Institute. Performance standards for antifungal susceptibility testing of yeasts. 60a ed. 14p
Clinical and Laboratory Standards Institute. Epidemiological cutoff values for antifungal susceptibility testing. 59ª ed. 14p
Siri L, Legarraga P, García P, González T, Rabagliati R. Cambios clínicos y epidemiológicos de candidemias en pacientes adultos desde 2000. Rev Chilena Infectol. 2017;34:19–26.
Kajihara T, Yahara K, Nagi M, Kitamura N, Hirabayashi A, Hosaka Y, et al. Distribution, trends, and antifungal susceptibility of Candida species causing candidemia in Japan. Med Mycol. 2022. https://doi.org/10.1093/mmy/myac071.
Mamali V, Siopi M, Charpantidis S, Samonis G, Tsakris A, Vrioni G. Increasing incidence and shifting epidemiology of candidemia in Greece: results from the first nationwide 10-Year Survey. J Fungi. 2022;8(2):116.
el Zakhem A, Istambouli R, Alkozah M, Gharamti A, Tfaily MA, Jabbour JF, et al. Predominance of candida glabrata among non-albicans candida species in a 16-year study of candidemia at a tertiary care center in Lebanon. Pathogens. 2021;10(1):1–10.
Israel S, Amit S, Israel A, Livneh A, Nir-Paz R, Korem M. The epidemiology and susceptibility of Candidemia in Jerusalem, Israel. Front Cell Infect Microbiol. 2019. https://doi.org/10.3389/fcimb.2019.00352.
Sakamoto Y, Kawabe K, Suzuki T, Sano K, Ide K, Nishigaki T, et al. Species distribution of candidemia and their susceptibility in a single Japanese university hospital: Prior micafungin use affects the appearance of candida Parapsilosis and elevation of micafungin mics in non-Parapsilosis candida species. J Fungi. 2021. https://doi.org/10.3390/jof7080596.
Xiao Z, Wang Q, Zhu F, An Y. Epidemiology, species distribution, antifungal susceptibility and mortality risk factors of candidemia among critically ill patients: a retrospective study from 2011 to 2017 in a teaching hospital in China. Antimicrob Resist Infect Control. 2019. https://doi.org/10.1186/s13756-019-0534-2.
Falces-Romero I, Romero-Gómez MP, Moreno-Ramos F, Mingorance J, García-Rodríguez J, Cendejas-Bueno E. Epidemiology of bloodstream Candida species in a Spanish tertiary care hospital as a guide for implementation of T2MR (T2CANDIDA®) for rapid diagnosis of candidemia. Med Mycol. 2021;59:350–4.
Tiraboschi IN, Pozzi NC, Farías L, García S, Fernández NB. Epidemiología, especies, resistencia antifúngica y evolución de las candidemias en un hospital universitario de Buenos Aires, Argentina, durante 16 años. Rev Chilena Infectol. 2017;34:431–40.
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. Infection. 2020;48(2):275–84.
Nucci M, Barreiros G, Guimarães LF, Deriquehem VAS, Castiñeiras AC, Nouér SA. Increased incidence of candidemia in a tertiary care hospital with the COVID-19 pandemic. Mycoses. 2021;64(2):152–6.
Kayaaslan B, Eser F, Kaya Kalem A, Bilgic Z, Asilturk D, Hasanoglu I, et al. Characteristics of candidemia in COVID-19 patients; increased incidence, earlier occurrence and higher mortality rates compared to non-COVID-19 patients. Mycoses. 2021;64(9):1083–91.
Villanueva F, Veliz J, Canasa K, Bellido E, Martell S, Ortega S, et al. Characteristics of fungemias in a peruvian referral center: 5-year retrospective analysis. Rev Peru Med Exp Salud Publica. 2020;37(2):276–81.
Pinto-Magalhães S, Martins A, Lacerda S, Filipe R, Prista-Leão B, Pinheiro D, et al. Candidemia in a Portuguese tertiary care hospital: analysis of a 2-year period. J Mycol Med. 2019;29(4):320–4.
Aguilar G, Araujo P, Lird G, Insaurralde S, Kawabata A, Ayala E, et al. Identification and susceptibility profile of Candida species isolated from hemocultures in hospitals in Paraguay. Pan Am J Public Health. 2020. https://doi.org/10.26633/RPSP.2020.34.
Espinel-Ingroff A, Turnidge J. Utilidad clínica de los puntos de corte epidemiológicos para interpretar los datos de la sensibilidad antifúngica de los mohos y levaduras de poca prevalencia. Rev Iberoam Micol. 2016;33:63–75.
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All authors contribute to the study conception and design. Material preparation, data collection and analysis were performed by VM, CB, CM, MPG and MC. The first draft of the manuscript was written by VM, CB and MC and all authors commented on previous versions of the manuscript. Overall supervision RB. All authors read and approved the final manuscript.
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Carbia, M., Medina, V., Bustillo, C. et al. Study of Candidemia and its Antifungal Susceptibility Profile at the University Hospital of Montevideo, Uruguay. Mycopathologia 188, 919–928 (2023). https://doi.org/10.1007/s11046-023-00744-y
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DOI: https://doi.org/10.1007/s11046-023-00744-y