Colombo Arnaldo L, Nucci Marcio, Park Benjamin J, Nouér Simone A, Arthington-Skaggs Beth, da Matta Daniel A, Warnock David, Morgan Juliette
Division of Infectious Diseases, Universidade Federal de São Paulo, Rua Botucatu 740, 04023-062 São Paulo, Brazil.
J Clin Microbiol. 2006 Aug;44(8):2816-23. doi: 10.1128/JCM.00773-06.
Candidemia studies have documented geographic differences in rates and epidemiology, underscoring the need for surveillance to monitor trends. We conducted prospective candidemia surveillance in Brazil to assess the incidence, species distribution, frequency of antifungal resistance, and risk factors for fluconazole-resistant Candida species. Prospective laboratory-based surveillance was conducted from March 2003 to December 2004 in 11 medical centers located in 9 major Brazilian cities. A case of candidemia was defined as the isolation of Candida spp. from a blood culture. Incidence rates were calculated per 1,000 admissions and 1,000 patient-days. Antifungal susceptibility tests were performed by using the broth microdilution assay, according to the Clinical and Laboratory Standards Institute guidelines. We detected 712 cases, for an overall incidence of 2.49 cases per 1,000 admissions and 0.37 cases per 1,000 patient-days. The 30-day crude mortality was 54%. C. albicans was the most common species (40.9%), followed by C. tropicalis (20.9%) and C. parapsilosis (20.5%). Overall, decreased susceptibility to fluconazole occurred in 33 (5%) of incident isolates, 6 (1%) of which were resistant. There was a linear correlation between fluconazole and voriconazole MICs (r = 0.54 and P < 0.001 [Spearman's rho]). This is the largest multicenter candidemia study conducted in Latin America and shows the substantial morbidity and mortality of candidemia in Brazil. Antifungal resistance was rare, but correlation between fluconazole and voriconazole MICs suggests cross-resistance may occur.
念珠菌血症研究已记录了发病率和流行病学的地域差异，凸显了监测趋势的必要性。我们在巴西开展了前瞻性念珠菌血症监测，以评估发病率、菌种分布、抗真菌药物耐药频率以及耐氟康唑念珠菌属的危险因素。2003年3月至2004年12月，在巴西9个主要城市的11个医疗中心进行了基于实验室的前瞻性监测。念珠菌血症病例定义为从血培养中分离出念珠菌属。发病率按每1000例入院患者和每1000患者日计算。根据临床和实验室标准协会指南，采用肉汤微量稀释法进行抗真菌药敏试验。我们共检测到712例病例，总体发病率为每1000例入院患者2.49例，每1000患者日0.37例。30天的粗死亡率为54%。白色念珠菌是最常见的菌种（40.9%），其次是热带念珠菌（20.9%）和近平滑念珠菌（20.5%）。总体而言，33株（5%）新分离株对氟康唑的敏感性降低，其中6株（1%）耐药。氟康唑和伏立康唑的最低抑菌浓度之间存在线性相关性（r = 0.54，P < 0.001[Spearman秩相关系数]）。这是拉丁美洲开展的最大规模的多中心念珠菌血症研究，显示了巴西念珠菌血症的高发病率和死亡率。抗真菌药物耐药情况罕见，但氟康唑和伏立康唑最低抑菌浓度之间的相关性表明可能存在交叉耐药。
