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BMC Infect Dis. 2016 Aug 20;16(1):433. doi: 10.1186/s12879-016-1767-9.

Outbreak of candidemia caused by fluconazole resistant Candida parapsilosis strains in an intensive care unit.

Author information

1
Ed. América Office Tower, SCN Q 1 BL F, - sala-1016, Asa Norte, Brasília, DF, 70711-905, Brazil. hpmarconi@gmail.com.
2
Ed. América Office Tower, SCN Q 1 BL F, - sala-1016, Asa Norte, Brasília, DF, 70711-905, Brazil.
3
Universidade Federal de São Paulo, Rua Pedro de Toledo, 669, quinto andar, São Paulo, SP, 04039-032, Brazil.

Abstract

BACKGROUND:

Candidemia is an increasing problem in tertiary care hospitals worldwide. Here, we report the first outbreak of candidemia caused by fluconazole-resistant C. parapsilosis (FRCP) strains in Brazil.

METHODS:

This was a cross-sectional study of clinical and microbiological data of all candidemic episodes diagnosed from July 2011 to February 2012 in a 200-bed tertiary care hospital. Initial yeast identification and susceptibility testing were performed using the VITEK 2 - System. Isolates of Candida spp. resistant to fluconazole were sent to a reference laboratory (LEMI-UNIFESP) for further molecular identification and confirmation of resistance by CLSI microdilution test. A multivariate analysis was conducted to identify factors associated with FRCP infection.

RESULTS:

We identified a total of 40 critically ill patients with candidemia (15 women) with a median age of 70 years. The incidence of candidemia was 6 cases/1,000 patients admissions, including 28 cases (70 %) of infection with C. parapsilosis, 21 of which (75 %) were resistant to fluconazole. In only 19 % of FRCP candidemia cases had fluconazole been used previously. The results of our study indicated that diabetes is a risk factor for FRCP candidemia (p = 0.002). Overall, mortality from candidemia was 45 %, and mortality from episodes of FRCP infections was 42.9 %.

CONCLUSIONS:

The clustering of incident cases in the ICU and molecular typing of strains suggest horizontal transmission of FRCP. Accurate vigilant monitoring for new nosocomial strains of FRCP is required.

KEYWORDS:

Antifungal treatment; Candida sp; Candidemia; Fluconazole resistance

PMID:
27544427
PMCID:
PMC4992558
DOI:
10.1186/s12879-016-1767-9
[Indexed for MEDLINE]
Free PMC Article

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