Send to

Choose Destination
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

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



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.


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.


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 %.


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.


Antifungal treatment; Candida sp; Candidemia; Fluconazole resistance

[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center