Background: The last NNIS report showed that candidemia is the fourth agent of bloodstream infection in the intensive care units in USA. Candida spp is the fifth cause of bloodstream infection in our intensive care units. The incidence of non-albicans species has bee increased in several centers. C. tropicalis is the second most common species causing candidemia in our hospital. Despite the importance of this subject, little attention has been paid to better characterize the factors associated with C. tropicalis bloodstream infection. Objective: to determine the clinical characteristics of patients who developed C. tropicalis bloodstream infection in the Hospital das Clínicas of University of São Paulo during a period of 6 years. Method: Hospital medical records of patients with C. tropicalis bloodstream infection from January 1, 1996 to December 2001, in the Hospital das Clínicas of University of São Paulo, were reviewed. Nosocomial C. tropicalis bloodstream infection was defined as patients with positive blood culture, clinical symptoms and more than 48 hours of hospitalization. A database was created using the program EPINFO, CDC, version 6.04. The following variables were evaluated: demographic data, hospital admission, outcome, underlying diseases, devices use, bleeding, surgery and previous antibiotic, antifungal and steroid therapy. Results: Forty-one patients were included. The age varied from less than 1 to 86 years, media of 45 years. Twenty four (58%) patients were male, the mean length of stay was 24 days, 73% of patients had an intensive care stay, the Apache II score media was 18. The most common underlying diseases were cancer (32%) and burned (12%). Twenty-nine (72%) patients died. Intravascular device and urinary catheter were employed in respectively 88% and 78% of patients. Forty (98%) patients received antibiotics, 24 (60%) received vancomycin, (52%) steroids and (88%) transfusion. The majority of patients had a GI tract disorder, (63%) had diarrhea and (39%) bleeding. Conclusion: Unlike the literature, our data show that C. tropicalis bloodstream infection occurred frequently in severe patients such as cancer and burned patients with high APACHE score media. The poor outcome of our patients could be related to the seriousness of patients or to the C. tropicalis infection. Since C. tropicalis colonizes GI tract, its can explain the frequency of GI tract disorder of our patients and hypothesis that GI tract could be one of the sources of infection.
Full conference title:
The 15 th Congress of the International Society for Human and Animal Mycology
- ISHAM 15th (2003)