Rodriguez Lourdes, Bustamante Beatriz, Huaroto Luz, Agurto Cecilia, Illescas Ricardo, Ramirez Rafael, Diaz Alberto, Hidalgo Jose
Guillermo Almenara Hospital, Lima, Peru.
Instituto de Medicina Tropical Alexander von Humboldt, Cayetano Heredia University, Lima, Peru.
PLoS One. 2017 Apr 18;12(4):e0175172. doi: 10.1371/journal.pone.0175172. eCollection 2017.
The incidence of candidemia is increasing in developing countries. Very little is known about the epidemiology of candidemia in Peru. The aim of this study is to describe the incidence, microbiology, clinical presentation and outcomes of Candida bloodstream infections in three Lima-Callao hospitals.
Candida spp. isolates were identified prospectively at participant hospitals between November 2013 and January 2015. Susceptibility testing for amphotericin B, fluconazole, posaconazole, voriconazole and anidulafungin was performed using broth microdilution method. Clinical information was obtained from medical records and evaluated.
We collected information on 158 isolates and 157 patients. Median age of patients was 55.0 yrs., and 64.1% were males. Thirty-eight (24.2%) episodes of candidemia occurred in those <18 yrs. The frequency of non-Candida albicans was 72.1%. The most frequently recovered species were C. albicans (n = 44, 27.8%), C. parapsilosis (n = 40, 25.3%), C. tropicalis (n = 39, 24.7%) and C. glabrata (n = 15, 9.5%). Only four isolates were resistant to fluconazole, 86.7% (n = 137) were susceptible and 17 were susceptible-dose dependent. Decreased susceptibility to posaconazole was also observed in three isolates, and one to voriconazole. All isolates were susceptible to anidulafungin and amphotericin B. The most commonly associated co-morbid conditions were recent surgery (n = 61, 38.9%), mechanical ventilation (n = 60, 38.2%) and total parenteral nutrition (n = 57, 36.3%). The incidence of candidemia by center ranged between 1.01 and 2.63 cases per 1,000 admissions, with a global incidence of 2.04. Only 28.1% of cases received treatment within 72 hrs. of diagnosis. Overall, the 30-day survival was 60.4% (treated subjects, 67.4%; not-treated patients, 50.9%).
We found a very high proportion of non-albicans Candida species. Despite this, the decreased susceptibility/resistance to fluconazole was only 13.3% and not seen in the other antifungals. Overall, the incidence of candidemia mortality was high when compared to other international studies. It is possible, that the delay in initiating antifungal treatment contributed to the elevated mortality rate, in spite of low antifungal resistance.
在发展中国家，念珠菌血症的发病率正在上升。关于秘鲁念珠菌血症的流行病学情况，人们知之甚少。本研究的目的是描述利马-卡亚俄地区三家医院念珠菌血流感染的发病率、微生物学特征、临床表现及转归。
2013年11月至2015年1月期间，在参与研究的医院对念珠菌属分离株进行前瞻性鉴定。采用肉汤微量稀释法对两性霉素B、氟康唑、泊沙康唑、伏立康唑和阿尼芬净进行药敏试验。从病历中获取临床信息并进行评估。
我们收集了158株分离株和157例患者的信息。患者的中位年龄为55.0岁，男性占64.1%。18岁以下患者发生念珠菌血症38例（24.2%）。非白色念珠菌的发生率为72.1%。最常分离出的菌种为白色念珠菌（n = 44，27.8%）、近平滑念珠菌（n = 40，25.3%）、热带念珠菌（n = 39，24.7%）和光滑念珠菌（n = 15，9.5%）。仅4株分离株对氟康唑耐药，86.7%（n = 137）敏感，17株为剂量依赖敏感。3株分离株对泊沙康唑敏感性降低，1株对伏立康唑敏感性降低。所有分离株对阿尼芬净和两性霉素B敏感。最常见的合并症为近期手术（n = 61，38.9%）、机械通气（n = 60，38.2%）和全胃肠外营养（n = 57，36.3%）。各中心念珠菌血症的发病率在每1000例入院患者中为1.01至2.63例，总体发病率为2.04。仅28.1%的病例在诊断后72小时内接受了治疗。总体而言，30天生存率为60.4%（接受治疗的患者为67.4%；未接受治疗的患者为50.9%）。
我们发现非白色念珠菌的比例非常高。尽管如此，对氟康唑的敏感性降低/耐药率仅为13.3%，其他抗真菌药物未见此情况。总体而言，与其他国际研究相比，念珠菌血症的死亡率较高。尽管抗真菌药物耐药率较低，但抗真菌治疗启动延迟可能导致了死亡率升高。
