Candidemia in a public hospital in Northeastern Brazil: Epidemiological features and risk factors in critically ill patients

Renata Baltar da Silva; Rejane Pereira Neves; Sylvia Lemos Hinrichsen; Reginaldo Gonçalves de Lima-Neto

doi:10.1016/j.riam.2019.06.003

Candidemia in a public hospital in Northeastern Brazil: Epidemiological features and risk factors in critically ill patients

Rev Iberoam Micol. 2019 Oct-Dec;36(4):181-185. doi: 10.1016/j.riam.2019.06.003. Epub 2019 Nov 20.

Authors

Renata Baltar da Silva¹, Rejane Pereira Neves², Sylvia Lemos Hinrichsen³, Reginaldo Gonçalves de Lima-Neto⁴

Affiliations

¹ Hospital das Clínicas de Pernambuco (HC/PE), Brazil; Nucleus of Education, Research and Assistance in Infectious Diseases, HC/PE, Brazil.
² Department of Mycology, Biosciences Center, Federal University of Pernambuco (UFPE), Brazil; Department of Tropical Medicine, Center of Health Science, UFPE, Brazil; Nucleus of Education, Research and Assistance in Infectious Diseases, HC/PE, Brazil.
³ Department of Tropical Medicine, Center of Health Science, UFPE, Brazil; Nucleus of Education, Research and Assistance in Infectious Diseases, HC/PE, Brazil.
⁴ Department of Tropical Medicine, Center of Health Science, UFPE, Brazil; Nucleus of Education, Research and Assistance in Infectious Diseases, HC/PE, Brazil. Electronic address: reginaldo.limaneto@pq.cnpq.br.

PMID: 31759839
DOI: 10.1016/j.riam.2019.06.003

Abstract

Background: Candidemia is a life-threatening fungal infection characterized by the presence of Candida in the blood.

Aims: To describe the clinical-epidemiological features and main risk factors among patients with candidemia admitted to Intensive Care Unit.

Methods: A cross-sectional, retrospective and observational study was performed between January 2015 and July 2016. Laboratory reports and medical records from ICU patients admitted to a public hospital in northeastern Brazil were analyzed.

Results: There were 1573 admissions and 67 of them were positive for candidemia. The majority of patients were male (53.3%) and remained at the hospital for more than seven days (86.6%). Non-C. albicansCandida infections (60%) were predominant. Broad-spectrum antibiotic therapy was prescribed in 98.4% of the cases. The most frequent underlying diseases were sepsis (73.3%), presence of solid tumors (15%), respiratory condition (60%), urinary tract disease (56.6%) and gastrointestinal tract diseases (23.3%). Surgeries were carried out on 43% of the patients, consisting of 23.3% abdominal surgeries, with a mortality rate of 92.8%. Risk factors were venous central access (93.3%), mechanical ventilation (81.6%), nasoenteral tube (83.3%), nasogastric tube (25%), indwelling bladder catheter (88.3%), diabetes mellitus (55%) and tracheostomy (36.6%). Statistical analysis correlated the use of indwelling bladder catheter with a higher mortality rate (r=0.07412, p=0.0353).

Conclusions: The current study reveals the high case fatality rates among critically ill patients suffering from candidemia admitted to ICU. Herein, we highlight the importance of identifying non-C. albicansCandida species and reinforce the idea of carrying out epidemiological surveillances and antifungal susceptibility tests.

Keywords: Candidemia; Características epidemiológicas; Critically ill patients; Epidemiologic characteristics; Factores de riesgo; Pacientes críticos; Risk factors.

Publication types

Observational Study

MeSH terms

Adult
Aged
Aged, 80 and over
Brazil / epidemiology
Candidemia / epidemiology*
Critical Illness
Cross-Sectional Studies
Female
Hospitals, Public
Humans
Male
Middle Aged
Retrospective Studies
Risk Factors