A prospective, multi-center study of Candida bloodstream infections in Chile

BackgroundActive 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.MethodsWe conducted a prospective, multicenter, laboratory-based survey study of candidemia in 26 tertiary care hospitals in Chile, from January 2013 to October 2017.ResultsA 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%).ConclusionsOur 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.

背景 主动监测对于改善念珠菌血症（candidemia）患者的管理与预后至关重要。本研究旨在描述智利三级医院收治的儿童与成人念珠菌血症患者的流行病学及临床特征。
方法 本研究于2013年1月至2017年10月期间，针对智利26家三级医院开展念珠菌血症前瞻性多中心实验室调查研究。
结果 本研究共纳入780例念珠菌血症发作例次，中位发病率为0.47例/1000入院人次。本报告纳入了来自18家医院（共计7416张床位）的384例念珠菌血症患者的人口学、临床及微生物学资料。其中134例次（35%）见于儿科患者，250例次（65%）见于成人人群。白假丝酵母菌（Candida albicans，占比39%）、近平滑假丝酵母菌（Candida parapsilosis，占比30%）及光滑假丝酵母菌（Candida glabrata，占比10%）为主要分离菌种，不同年龄组的菌种分布存在显著差异。中心静脉导管（central venous catheter）置入与抗菌药物使用为所有年龄组最常见的危险因素（占比均＞70%）。本研究对315株菌株开展了抗真菌药物敏感性试验（antifungal susceptibility），其中21株（6.6%）对氟康唑（fluconazole）、伊曲康唑（itraconazole）、伏立康唑（voriconazole）、阿尼芬净（anidulafungin）或米卡芬净（micafungin）耐药。最常用的抗真菌治疗方案为氟康唑（39%）与棘白菌素类（echinocandins，占比36%）。整体30天生存率为74.2%，婴儿（82%）与儿童（86%）的30天生存率显著高于新生儿（72%）、成人（71%）及老年患者（70%）。
结论 本项前瞻性多中心监测研究显示，智利念珠菌血症发病率较低，30天生存率较高，老年患者占比较高，光滑假丝酵母菌为第三常见分离菌株，抗真菌药物耐药率达6.6%，棘白菌素类药物使用较为普遍。