Epidemiología de la candidemia en el Hospital México

Autores/as

  • Juan Manuel Villalobos Vindas Caja Costarricense del Seguro Social, Hospital México
  • José Antonio Castro Cordero Caja Costarricense del Seguro Social, Hospital México
  • Álvaro Avilés Montoya Caja Costarricense del Seguro Social, Hospital México
  • María Claudia Peláez Gil Caja Costarricense del Seguro Social, Hospital México
  • Teresita Somogyi Pérez Caja Costarricense del Seguro Social, Hospital México
  • Lilliana Sandoval Carpio Caja Costarricense del Seguro Social, Hospital México

DOI:

https://doi.org/10.51481/amc.v58i1.908

Palabras clave:

Candida parapsilosis, candidemia, fungemia, sepsis, síndrome de respuesta inflamatoria sistémica

Resumen

Justificación y objetivos: las infecciones invasivas por Candida son frecuentes y de alta mortalidad en la práctica clínica. Existe poca información publicada al respecto en el país. Estudio retrospectivo y observacional que pretende aportar conocimiento novedoso sobre la epidemiología local de la candidemia.

Métodos: se incluyó 136 pacientes mayores de 17 años en su primer episodio de candidemia, internados en el Hospital México, entre 2007 y 2010. Se realizó un análisis descriptivo y temporal, se evaluaron los factores asociados con C. parapsilosis y con la sobrevida a 30 días.

Resultados: se detectó en promedio 34 episodios por año (rango 27 a 51), la incidencia acumulada fue de 1,1 casos/1000 admisiones. Las especies de Candida no albicans constituyeron el 62% de las levaduras aisladas. Exceptuando 2009, C. parapsilosis fue la especie predominante en 3 de 4 años estudiados (41%), seguida por C. albicans (38%). Se demostró una fuerte asociación entre la candidemia por C. parapsilosis, la presencia de catéter venoso central (OR=19,6, IC95%: 2,6 a 403,8, p<0,001) y el uso de nutrición parenteral (p=0,014). La mortalidad a 30 días fue del 46%. C. albicans mostró la mortalidad más alta y C. parapsilosis, la más baja. Los pacientes que no recibieron tratamiento antifúngico presentaron una probabilidad significativamente mayor de morir.

Conclusiones: la elevada incidencia de candidemia por C. parapsilosis está directamente relacionada con los catéteres venosos centrales y el uso de nutrición parenteral; su marcada reducción en la frecuencia durante 2009, merece ser investigada para dilucidar los factores que provocaron este cambio.

Descargas

Los datos de descargas todavía no están disponibles.

Citas

Bouza E, Muñoz P. Epidemiology of candidemia in intensive care units. International J Antimicrob Agents 2008; 32:S87-S91.

Darouiche RO. Candida in the ICU. Clin Chest Med 2009; 30:287-93.

Guery BP, Arendrup MC, Auzinger G, Azoulay E, Borges Sá M, Johnson EM, et al. Management of invasive candidiasis and candidemia in adult nonneutropenic intensive care unit patients: Part I. Epidemiology and diagnosis. Intensive Care Med 2009; 35:55-62.

Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004, 39:309-17.

Pfaller MA, Jones RN, Doern GV, Sader HS, Holli RJ, Messer SA. For the SENTRY Participant Group. International surveillance of blood stream infection due to Candida species: frequency of occurrence and antifungal susceptibility of isolates collected in 1997 in the United States, Canada, and South America for the SENTRY Program. J Clin Microbiol 1998; 36:1886-9.

Pfaller MA, Jones RN, Doren GV, Sader HS, Hollis RJ, Messer SA, et al. International surveillance of blood stream infections due to Candida species in the European SENTRY Program: species distribution and antifungal susceptibility including the investigational triazole and echinocandin agents. Diag Microbiol Infect Dis 1999; 35:19-25.

Pfaller MA, Diekema DJ. Role of Sentinel Surveillance of Candidemia: Trends in Species Distribution and Antifungal susceptibility. J Clin Microbiol 2002; 40:3551-57.

Trofa D, Gácser A, Nosanchuk JD. Candida parapsilosis, an Emerging Fungal Pathogen. Clin Microbiol Rev 2008; 21: 606-25.

Gagne JJ, Goldfarb NI. Candidemia in the in-patient setting: treatment options and economics. Expert Opin Pharmachother 2007; 8:1643-50.

Caballero E, Boza R, González K. Candidiasis sistémica – Experiencia en el Hospital San Juan de Dios 1996 – 1998. Rev Costarric Cienc Méd 1999; 20:153-65.

Mora N, Carrillo P. Candidemia en el Hospital San Juan de Dios: casos del 2003 al 2005. Rev. Colegio de Microbiólogos y Químicos Clínicos de Costa Rica 2005; 11:17-19.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. See comment in PubMed Commons belowJ Chronic Dis 1987; 4:373-83.

Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 2011; 173:676-82.

Almirante B, Rodríguez D, Park BJ, Cuenca-Estrella M, Planes AN, Almela M, et al. Epidemiology and predictors of mortality in cases of Candida bloodstream infection: results from population-based surveillance, Barcelona, Spain, from to 2002 to 2003. J Clin Microbiol 2005; 43:1829-35.

Bennet JE. Echinocandins for Candidemia in Adults without Neutropenia. N Engl J Med 2006; 355:1154-59.

Nucci M, Queiroz-Telles F, Alvarado-Matute T, Tiraboschi I, Cortes J, Zurita J, et al. Epidemiology of candidemia in Latin America: a laboratory-based survey. PLoS ONE 2013; 8: e59373.

Colombo AL, Nucci M, Park BJ, Nouer SA, Arthington-Skaggs B, da Matta DA, et al. Epidemiology of candidemia in Brazil: a nationwide sentinel surveillance of candidemia in eleven medical centers. J Clin Microbiol 2006; 44:2816-23.

Tortorano AM, Kibbler C, Peman J, Bernhardt H, Klingspor L, Grillot R. Candidemia in Europe: epidemiology and resistance. International J Antimicrob Agents 2006; 27:359-66.

Diekema DJ, Messer SA, Hollis DJ, Boyken L, Tendolkarb S, Kroeger J, et al. A global evaluation of voriconazole activity tested against recent clinical isolates of Candida spp. Diagn Microbiol Infect Dis 2009; 63:233-36.

Colombo AL, Nucci M, Salomao R, Branchini ML, Richtmann R, Derossi A, Wey SB. High rate of nonalbicans candidemia in Brazilian tertiary care hospitals. Diagn Microbiol Infect Dis 1999; 34:281-86.

Borges M, Zaragoza R. Critical overview of clinical guidelines relating to invasive fungal infections. International J Antimicrob Agents 2008; 32:S155– S159.

Calandra T, Marchetti O. Clinical trials of antifungal prophylaxis among patients undergoing surgery. Clin Infect Dis 2004; 39:S185-S192.

Nakamura T, Takahashi H. Epidemiological study of Candida infections in blood: susceptibilities of Candida spp. to antifungal agents, and clinical features associated with the candidemia. J Infect Chemother 2006; 12:132-38.

Asmundsdottir LR, Erlendsdottir H, Gottfredsson M. Increasing incidence of candidemia: results from a 20-year nationwide study in Iceland. J Clin Microbiol 2002; 40: 3489-92.

Colombo AL, Nucci M, Park BJ, Nouér SA, Arthington-Skaggs B, da Matta DA, et al. Epidemiology of Candidemia in Brazil: a Nationwide Sentinel Surveillance of Candidemia in Eleven Medical Centers. J Clin Microbiol 2006; 44:2816-23.

Brito LR, Guimaraes T, Nucci M, Rosas RC, Almeida LP, da Matta DA, et al. Clinical and microbiological aspects of candidemia due to Candida parapsilosis in Brazilian tertiary care hospitals. Med Mycol 2006; 44: 261-66.

Diekema DJ, Pfaller MA. Nosocomial candidemia: an ounce of prevention is better than a pound of cure. Infect Control Hosp Epidemiol 2004; 25:624-26.

Dizbay M, Fidan I, Kalkanci A, Sari N, Yalcin B, Kustimur S, et al. High incidence of Candida parapsilosis Candidaemia in non-neutropenic critically ill patients: Epidemiology and antifungal susceptibility. Scand J Infect Dis 2010; 42:114-20.

Huang YC, Lin TY, Leu HS, Peng HL, Wu JH, Chang HY. Outbreak of Candida parapsilosis fungemia in neonatal intensive care units: clinical implications and genotyping analysis. Infection 1999; 27:97-102.

Levin AS, Costa SF, Mussi NS, Basso M, Sinto SI, Machado C, et al. Candida parapsilosis fungemia associated with implantable and semi-implantable central venous catheters and the hands of healthcare workers. Diagn Microbiol Infect Dis 1998; 30: 243-9.

Medrano DJ, Brilhante RS, Cordeiro RA, Rocha MF, Rabenhorst SH, Sidrim JJ. Candidemia in a Brazilian hospital: the importance of Candida parapsilosis. Rev Inst Med Trop Sao Paulo 2006; 48:17-20.

Hawser SP, Douglas LJ. Biofilm formation by Candida species on the surface of catheter materials in vitro. Infect Immun 1994; 62:915-21.

Branchini, ML, Pfaller MA, Rhine-Chalberg J, Frempong T, Isenberg HD. Genotypic variation and slime production among blood and catheter isolates of Candida parapsilosis. J Clin Microbiol 1994; 32:452-6.

Ramage G, Saville SP, Thomas DP, Lopez-Ribot JL. Candida biofilms: an update. Eukaryot Cell 2005; 4: 633-8.

Silva S, Negri M, Henriques M, Oliveira R, Williams DW, Azeredo J. Adherence and biofilm formation of non-Candida albicans Candida species. Trends in Microbiology 2011; 19: 241-47.

Weems JJ, Chamberland ME, Ward J, Willy M, Padhye AA, Solomon SL. Candida parapsilosis fungemia associated with parenteral nutrition and contaminated blood pressure transducers. J Clin Microbiol 1987; 25: 1029-32.

Pfaller MA. Nosocomial candidiasis: emerging species, reservoirs, and modes of transmission. Clin Infect Dis 1996; 22: S89-S94.

Eggimann P, Garbino J, Pittet D. Epidemiology of Candida species infections in critically ill non-immunosuppressed patients. Lancet Infect Dis 2003; 3: 685702.

Kollef M, Micek S, Hampton N, Doherty JA, Kumar A. Septic shock attributed to Candida infection: importance of empiric therapy and source control. Clin Infect Dis 2012; 54: 1739-46.

Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of Candida bloodstream infection until obtaining positive blood culture results: A potential risk factor for hospital mortality. Antimicrob Agents Chemother 2005; 49:3640-45.

Garey KW, Rege M, Pai MP. Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: A multicenter study. Clin Infect Dis 2006; 43:25-31.

Grim SA, Berger K, Teng C, Gupta S, Layden JE, Janda WM, et al. Timing of susceptibility-based antifungal drug administration in patients with Candida bloodstream infection: correlation with outcomes. J Antimicrob Chemother 2012; 67: 707-14.

Descargas

Publicado

2016-02-02 — Actualizado el 2016-02-02

Versiones

Cómo citar

Vindas, J. M. V., Cordero, J. A. C., Montoya, Álvaro A., Gil, M. C. P., Pérez, T. S., & Carpio, L. S. (2016). Epidemiología de la candidemia en el Hospital México. Acta Médica Costarricense, 58(1), 15–21. https://doi.org/10.51481/amc.v58i1.908

Artículos más leídos del mismo autor/a