Date Published: March 8, 2019
Publisher: Public Library of Science
Author(s): Maria E. Santolaya, Luis Thompson, Dona Benadof, Cecilia Tapia, Paulette Legarraga, Claudia Cortés, Marcela Rabello, Romina Valenzuela, Pamela Rojas, Ricardo Rabagliati, Alix Therese Coste.
Active surveillance is necessary for improving the management and outcome of patients with candidemia. The aim of this study was to describe epidemiologic and clinical features of candidemia in children and adults in tertiary level hospitals in Chile.
We conducted a prospective, multicenter, laboratory-based survey study of candidemia in 26 tertiary care hospitals in Chile, from January 2013 to October 2017.
A total of 780 episodes of candidemia were included, with a median incidence of 0.47/1,000 admissions. Demographic, clinical and microbiological information of 384 cases of candidemia, from 18 hospitals (7,416 beds), was included in this report. One hundred and thirty-four episodes (35%) occurred in pediatric patients and 250 (65%) in adult population. Candida albicans (39%), Candida parapsilosis (30%) and Candida glabrata (10%) were the leading species, with a significant difference in the distribution of species between ages. The use of central venous catheter and antibiotics were the most frequent risk factors in all age groups (> 70%). Three hundred and fifteen strains were studied for antifungal susceptibility; 21 strains (6.6%) were resistant to fluconazole, itraconazole, voriconazole, anidulafungin or micafungin. The most commonly used antifungal therapies were fluconazole (39%) and echinocandins (36%). The overall 30-day survival was 74.2%, significantly higher in infants (82%) and children (86%) compared with neonates (72%), adults (71%) and elderly (70%).
Our prospective, multicenter surveillance study showed a low incidence of candidemia in Chile, with high 30-day survival, a large proportion of elderly patients, C. glabrata as the third most commonly identified strain, a 6.6% resistance to antifungal agents and a frequent use of echinocandins.
Candida bloodstream infection is a major cause of morbidity and mortality in hospitalized pediatric and adult patients worldwide [1–4], becoming the most common etiology of positive blood cultures in some centers in Europe and USA [5,6]. This increasing frequency is explained by the growth of populations which are at high risk of candidemia, such as immunocompromised patients, preterm neonates, elderly patients and patients admitted to Intensive Care Units (ICU) . Unfortunately, along with the larger at-risk population, we still face numerous difficulties in the diagnosis, such as delayed confirmation and late start of appropriate antifungal therapy, which contribute to the high mortality rate [8, 9].
Our study is, to date, the largest epidemiological report of candidemia in Chile. By including cases in children and adults, located throughout the country, it provides robust epidemiological information, which could contribute to a better understanding of candidemia in the region. Our results allowed the characterization of candidemia in Chile and identified differences with other Latin-American countries, as the lowest incidence in the region with 0.47 cases per 1,000 admissions, with predominance of C. albicans, followed by C. parapsilosis and C. glabrata. Additional differences with the Latin-American study were that cases were more frequent in the elderly (38.55 versus 22.6%), having twice rate of antifungal resistance (6.65 versus 3.1%) and higher 30-day survival (74.2% versus 59.3%) .