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Ten-Year Study of Species Distribution and Antifungal Susceptibilities of Candida Bloodstream Isolates at a Brazilian Tertiary Hospital

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Abstract

To describe the incidence and susceptibility profile of Candida bloodstream infections in a tertiary-care hospital, we performed a retrospective observational study from 1998 to 2007. Comorbidities and risk factors were compiled from all cases. In vitro susceptibility testing to fluconazole, itraconazole, voriconazole, and amphotericin B was performed for 100 isolates, and caspofungin was tested for C. parapsilosis complex. In a ten-year evaluation of candidemias, 44 % were caused by C. albicans, and species of the C. parapsilosis complex were the second most frequent agents (37 %). Other species presented lower incidences (C. tropicalis, 13 %, C. glabrata, 5 %, and C. krusei, 1 %). Neither C. dubliniensis nor C. metapsilosis were observed in this study. C. orthopsilosis (3 %) and C. parapsilosis stricto sensu (34 %) were also found. Species distribution was independent of catheterization, mechanical ventilation, or previous use of antifungals or corticoids. Parenteral nutrition administration was strongly related to C. glabrata infection, and the highest mortality (80 %) was observed in patients infected by this species. All C. albicans isolates showed high susceptibility to all tested drugs. However, two C. parapsilosis stricto sensu isolates presented high minimum inhibitory concentration (MIC) (4 mg/L each) to fluconazole, and one exhibited voriconazole MIC of 0.25 mg/L, highlighting the cross-resistance to these azoles. All isolates of C. tropicalis and C. glabrata showed no resistance to any drug tested. No difference was noted between C. parapsilosis and C. orthopsilosis susceptibilities to caspofungin. Our results suggest that resistance to amphotericin B, fluconazole, voriconazole, itraconazole, and caspofungin in Brazilian Candida bloodstream isolates is still uncommon.

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Acknowledgments

The authors would like to thank Andrés Avelino Baez for the excellent technical support, to Dulcilena de Matos in charge of the culture collection. S.U.P. was supported by a master grant from CAPES (Coordenação de Aperfeiçoamento de Pessoal do Ensino Superior, and L.X.B. are supported by a master grant from FAPESP (Fundação de Apoio à Pesquisa do Estado de São Paulo).

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Authors and Affiliations

  1. Mycology Unit, Adolfo Lutz Institute Adolfo Lutz, Av. Dr. Arnaldo 355, São Paulo, 01246-902, Brazil

    L. X. Bonfietti, M. W. Szeszs, M. A. Martins, S. R. B. S. Pukinskas, M. O. Nunes, S. U. Purisco & M. S. C. Melhem

  2. Federal University of Mato Grosso do Sul, Mato Grosso do Sul, Brazil

    M. R. Chang

  3. Nipo-Brasileiro Hospital, São Paulo, Brazil

    G. H. Pereira

  4. University Hospital of Mato Grosso do Sul, Mato Grosso do Sul, Brazil

    A. M. M. Paniago

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  1. L. X. Bonfietti
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  2. M. W. Szeszs
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  3. M. R. Chang
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  4. M. A. Martins
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Correspondence to M. S. C. Melhem.

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Bonfietti, L.X., Szeszs, M.W., Chang, M.R. et al. Ten-Year Study of Species Distribution and Antifungal Susceptibilities of Candida Bloodstream Isolates at a Brazilian Tertiary Hospital. Mycopathologia 174, 389–396 (2012). https://doi.org/10.1007/s11046-012-9566-3

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