MycologyCandidemia due to Candida tropicalis: clinical, epidemiologic, and microbiologic characteristics of 188 episodes occurring in tertiary care hospitals
Introduction
Candidemia is a major problem in tertiary care hospitals all over the world, with rates ranging from 0.20 to 0.96 cases per 1000 admissions (Pittet and Wenzel, 1995, Tortorano et al., 2004, Wisplinghoff et al., 2004). In a recent prospective epidemiologic study conducted in 11 Brazilian medical centers, we observed a much higher incidence of candidemia (2.49 cases per 1000 admissions) (Colombo et al., 2006). In addition to these differences in the incidence, we also observed that Candida tropicalis was the 2nd most frequent species, accounting for 20.9% of all candidemias, a much higher proportion than that reported in North American and European series (Almirante et al., 2005, Asmundsdottir et al., 2002, Garbino et al., 2002, Pappas et al., 2003, Poikonen et al., 2003, Tortorano et al., 2004). Candidemia due to C. tropicalis has been observed more frequently in patients with cancer and neutropenia (Wingard, 1995). However, in our series, high proportions of cases of candidemia due to C. tropicalis were also observed in different clinical scenarios and across all age groups. The reasons for these observations are not clear. In this study, we attempted to characterize the epidemiology, microbiology, and outcome of candidemia due to C. tropicalis by comparing patients with candidemia due to C. tropicalis with those with candidemia due to Candida albicans.
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Materials and methods
For this analysis, we merged 2 databases of candidemia that were generated from 2 periods of prospective laboratory-based surveillance in 12 tertiary care academic medical centers in 10 cities of the south, southeast, and central regions of Brazil in 2 periods: March 2003 to December 2004 (712 episodes of candidemia in 11 centers) and April 2005 to February 2006 (212 episodes in 5 centers). All hospitals had automated blood culture systems (BACTEC [Becton Dickinson, Sparks, MD, USA] or
Results
A total of 924 episodes of candidemia were observed in 906 patients (2 episodes of candidemia in 16 patients and 3 episodes in 1 patient). C. albicans was the most frequent species (384 cases, 41.5%), followed by C. tropicalis (188 cases, 20%) and Candida parapsilosis (187 cases, 20%). The proportion of candidemias caused by C. tropicalis varied among the 12 institutions from 15.7% to 25.8% (median, 19.7%). The median age of patients with candidemia due to C. tropicalis was 53 years (range,
Discussion
The etiology of candidemia has evolved over the past 20 years, with a shift from C. albicans to nonalbicans species, especially C. tropicalis, C. parapsilosis, Candida glabrata, and Candida krusei (Colombo et al., 1999, San Miguel et al., 2005, Trick et al., 2002). The reasons for the emergence of nonalbicans species are not completely understood, but some medical conditions may consistently impact the risk of developing candidemia due to nonalbicans species: C. parapsilosis fungemia has been
Acknowledgment
This study was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil, grants 300235/93-3 (Dr. Marcio Nucci) and 301942/03-0 (Dr. Arnaldo Colombo).
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