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J Infect. 2006 Mar;52(3):216-22. Epub 2005 Jun 3.

Risk factors and outcome for nosocomial breakthrough candidaemia.

Author information

1
Department of Infection Control, Santa Casa Complexo Hospitalar, Porto Alegre, Brazil. alessandro.pasqualotto@manchester.ac.uk

Abstract

OBJECTIVES:

To describe all cases of nosocomial candidaemia that occurred in patients in use of anti-fungals.

METHODS:

Retrospective cohort study (1995-2003). Breakthrough candidaemia was defined as the occurrence of candidaemia in a patient receiving at least 3 days of systemic anti-fungal therapy. Patients with breakthrough candidaemia were compared to patients with non-breakthrough candidaemia.

RESULTS:

During the period of study, 20 patients had breakthrough candidaemia, and 40% of them had cancer. While most of these episodes occurred with amphotericin B, some patients received low-dose regimens of fluconazole or ketoconazole in association with ranitidine. Non-Candida albicans species caused 75% of these infections, mainly Candida parapsilosis (30%). When compared to controls (n=171), the breakthrough group had more frequently mucositis, longer stay in the intensive care unit, and longer periods of hyperalimentation, mechanical ventilation, urinary catheter and broad-spectrum antibiotics. Candida isolation from sites other than blood occurred more frequently in the breakthrough group. Mortality rate and Candida species distribution were similar among groups.

CONCLUSIONS:

C. parapsilosis was the main aetiology of breakthrough candidaemia. Common risk factors included mucositis, isolation of Candida from sites other than blood, use of broad-spectrum antibiotics, and invasive medical procedures. No difference in the mortality rate was observed.

PMID:
15936825
DOI:
10.1016/j.jinf.2005.04.020
[Indexed for MEDLINE]

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