Species distribution and antifungal susceptibility profile of Candida spp. bloodstream isolates from Latin American hospitals

From March 1999 to March 2000, we conducted a prospective multicenter study of candidemia involving five tertiary care hospitals from four countries in Latin America. Yeast isolates were identified by classical methods and the antifungal susceptibility profile was determined according to the National Committee for Clinical Laboratory Standards microbroth assay method. During a 12 month-period we were able to collect a total of 103 bloodstream isolates of Candida spp. C. albicans was the most frequently isolated species accounting for 42% of all isolates. Non-albicans Candida species strains accounted for 58% of all episodes of candidemia and were mostly represented by C. tropicalis (24.2%) and C. parapsilosis (21.3%). It is noteworthy that we were able to identify two cases of C. lusitaniae from different institutions. In our casuistic, non-albicans Candida species isolates related to candidemic episodes were susceptible to fluconazole. Continuously surveillance programs are needed in order to identify possible changes in the species distribution and antifungal susceptibility patterns of yeasts that may occurs after increasing the use of azoles in Latin American hospitals.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Hospital São PauloUniversidad de Buenos Aires Hospital de Clínicas José de San MartínSanta Casa de Porto Alegre Instituto Especializado em Pesquisa e DiagnósticoHospital Cayetano HerediaUniversidad del Zulia Hospital Universitário de MaracaiboUNIFESP, EPM, Hospital São PauloSciEL

Epidemiology of Candidemia in Latin America: A Laboratory-Based Survey

Background: the epidemiology of candidemia varies depending on the geographic region. Little is known about the epidemiology of candidemia in Latin America.Methods: We conducted a 24-month laboratory-based survey of candidemia in 20 centers of seven Latin American countries. Incidence rates were calculated and the epidemiology of candidemia was characterized.Results: Among 672 episodes of candidemia, 297 (44.2%) occurred in children (23.7% younger than 1 year), 36.2% in adults between 19 and 60 years old and 19.6% in elderly patients. the overall incidence was 1.18 cases per 1,000 admissions, and varied across countries, with the highest incidence in Colombia and the lowest in Chile. Candida albicans (37.6%), C. parapsilosis (26.5%) and C. tropicalis (17.6%) were the leading agents, with great variability in species distribution in the different countries. Most isolates were highly susceptible to fluconazole, voriconazole, amphotericin B and anidulafungin. Fluconazole was the most frequent agent used as primary treatment (65.8%), and the overall 30-day survival was 59.3%.Conclusions: This first large epidemiologic study of candidemia in Latin America showed a high incidence of candidemia, high percentage of children, typical species distribution, with C. albicans, C. parapsilosis and C. tropicalis accounting for the majority of episodes, and low resistance rates.independent medical grant from Pfizer Inc.Univ Fed Rio de Janeiro, Univ Hosp, Rio de Janeiro, BrazilUniv Fed Parana, Hosp Clin, BR-80060000 Curitiba, Parana, BrazilHosp Escuela Tegucigalpa, Tegucigalpa, HondurasHosp Clin Jose San Martin, Buenos Aires, DF, ArgentinaUniv Nacl Colombia, Dept Internal Med, Bogota, ColombiaPontificia Univ Catolica Ecuador, Fac Med, Hosp Vozandes, Quito, EcuadorHosp Vargas de Caracas, Caracas, VenezuelaCtr Med Caracas, Caracas, VenezuelaUniv Chile, Fac Med, Dept Pediat, Hosp Luis Calvo Mackenna, Santiago 7, ChileUniv Desarrollo, Clin Alemana, Dept Med, Infect Dis Unit, Santiago, ChileInst Nacl Ciencias Med & Nutr Salvador Zubiran, Mexico City, DF, MexicoUniv Peruana Cayetano Heredia, Dept Med, Lima, PeruUniversidade Federal de São Paulo, Escola Paulista Med, Div Infect Dis, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Div Infect Dis, São Paulo, BrazilWeb of Scienc

First case report of bloodstream infection due to a Candida species closely related to the novel species Candida pseudorugosa

Fil: Taverna, Constanza Giselle. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento Micología; Argentina.Fil: Córdoba, Susana. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento Micología; Argentina.Fil: Isla, Guillermina. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento Micología; Argentina.Fil: Fernández, Norma. Hospital de Clínicas José de San Martín. División Infectología. Sección Micología; Argentina.Fil: García, Susana. Hospital de Clínicas José de San Martín. Departamento de Bioquímica Clínica. División Bacteriología; Argentina.Fil: Mazza, Mariana. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento Micología; Argentina.Fil: Murisengo, Omar Alejandro. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento Micología; Argentina.Fil: Vivot, Walter. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento Micología; Argentina.Fil: Szusz, Wanda. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento Micología; Argentina.Fil: Davel, Graciela. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento Micología; Argentina.Fil: Tiraboschi, Iris Nora. Hospital de Clínicas José de San Martín. División Infectología. Sección Micología; Argentina.Fil: Bosco-Borgeat, María Eugenia. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento Micología; Argentina.Candida pseudorugosa is a novel species closely related to Candida rugosa for which only one case has been reported. We report the first case of a bloodstream infection in humans caused by a Candida sp. closely related to C. pseudorugosa. We contribute evidence to show this organism as a potential human pathogen that may be misidentified by conventional methods, also pointing out its lower sensitivity to azoles and other antifungal agents

Surveillance of Candida spp Bloodstream Infections: Epidemiological Trends and Risk Factors of Death in Two Mexican Tertiary Care Hospitals

Introduction: Larger populations at risk, broader use of antibiotics and longer hospital stays have impacted on the incidence of Candida sp. bloodstream infections (CBSI).Objective: To determine clinical and epidemiologic characteristics of patients with CBSI in two tertiary care reference medical institutions in Mexico City.Design: Prospective and observational laboratory-based surveillance study conducted from 07/2008 to 06/2010.Methods: All patients with CBSI were included. Identification and antifungal susceptibility were performed using CLSI M27-A3 standard procedures. Frequencies, Mann-Whitney U test or T test were used as needed. Risk factors were determined with multivariable analysis and binary logistic regression analysis.Results: CBSI represented 3.8% of nosocomial bloodstream infections. Cumulative incidence was 2.8 per 1000 discharges (incidence rate: 0.38 per 1000 patient-days). C. albicans was the predominant species (46%), followed by C. tropicalis (26%). C. glabrata was isolated from patients with diabetes (50%), and elderly patients. Sixty-four patients (86%) received antifungals. Amphotericin-B deoxycholate (AmBD) was the most commonly used agent (66%). Overall mortality rate reached 46%, and risk factors for death were APACHE II score >= 16 (OR = 6.94, CI95% = 2.34-20.58, p<0.0001), and liver disease (OR = 186.11, CI95% = 7.61-4550.20, p = 0.001). Full susceptibility to fluconazole, AmBD and echinocandins among C. albicans, C. tropicalis, and C. parapsilosis was observed.Conclusions: the cumulative incidence rate in these centers was higher than other reports from tertiary care hospitals from Latin America. Knowledge of local epidemiologic patterns permits the design of more specific strategies for prevention and preemptive therapy of CBSI.Pfizer Inc.Salvador Zubiran Natl Inst Med Sci & Nutr, Dept Med, Mexico City, DF, MexicoHosp Escuela Tegucigalpa, Tegucigalpa, HondurasUniversidade Federal de São Paulo, Escola Paulista Med, Div Infect Dis, São Paulo, BrazilNatl Canc Inst, Div Infect Dis, Mexico City, DF, MexicoUniv Nacl Colombia, Dept Internal Med, Bogota, ColombiaUniv Peruana Cayetano Heredia, Dept Med, Lima, PeruHosp Vargas Caracas, Caracas, VenezuelaCtr Med Caracas, Caracas, VenezuelaUniv Fed Rio de Janeiro, Univ Hosp, Rio de Janeiro, BrazilUniv Texas Med Sch Houston, Mem Hermann Texas Med Ctr, Dept Med, Houston, TX USAUniv Fed Parana, Hosp Clin, BR-80060000 Curitiba, Parana, BrazilUniv Chile, Fac Med, Hosp Luis Calvo Mackenna, Dept Pediat, Santiago 7, ChileUniv Desarrollo, Clin Alemana, Dept Med, Santiago, ChileHosp Clin Jose San Martin, Infect Dis Unit, Buenos Aires, DF, ArgentinaPontificia Univ Catolica Ecuador, Fac Med, Hosp Vozandes, Quito, EcuadorUniversidade Federal de São Paulo, Escola Paulista Med, Div Infect Dis, São Paulo, BrazilPfizer Inc.: INF-168Web of Scienc

E.L.I.S.A. en coccidioidomicosis humana

Se realizó E.L.I.S.A. con exoantígeno de Coccidioides immitis para la detectión de anticuerpos, en 67 sueros humanos diluidos 1/1000, 1/2000, 1/4000 y 1/8000. De los 18 sueros de enfermos de coccidioidomicosis comprobada por examen directo, cultivo y/o histología, 5 fueron negativos, en otros 13 fueron positivos en una o varias diluciones. 3/26 sueros de personas sanas, coccidioidino positivas, fueron positivos en títulos de 1/1000 y el resto no tuvo anticuerpos detectables. No presentaron reacciones positivas ninguno de los sueros controles de personas sanas, pero sí lo hicieron 4/8 pacientes con otras micosis. Se concluye que E.L.I.S.A. es útil para la detección de mínimas cantidades de anticuerpos o en sueros que no pueden ser procesados por fijación de complemento. No es recomendable el uso de la técnica en forma aislada por al presencia de reacciones cruzadas.An E.L.I.S.A. test for antibody detection, with an exo-antigen of Coccidioides immitis was standardized in 67 humans sera diluited in 1/1000, 1/2000, 1/4000 and 1/8000. Eightheen sera from mycologically proved cases of coccidioidomycosis were studied: 5 were negative and 13 were positive in some dilutions. 3/26 sera of healthy persons who presented positive skin tests with coccidioidin were positive and the other 23 sera did not have positive reactions. None of the 15 sera of healthy human exhibited positive E.L.I.S.A. Serum samples of 8 patients suffering other deep mycosis were studied, 4 of them presented cross-reactions in E.L.I.S.A. tests. E.L.I.S.A. test seems to be a useful Serologic technique for antibody detection in anticomplementary serum samples or when a low concentration of antibodies should be detected. As it is very sensitive, cross-reactions with other mycoses are frequent, thus the use other more specific serologic technique together E.L.I.S.A. is recommended

First clinical isolation of an azole-resistant aspergillus fumigatus isolate harboring a TR46 Y121F T289A mutation in South America

One of the most recently described Aspergillus fumigatus CYP51Amediated azole resistance mechanisms is TR46 Y121F T289A. Clinical A. fumigatus strains harboring these substitutions have been reported worldwide, with the exception of South America. We describe the first clinical A. fumigatus strain with this resistance mechanism isolated from an Argentinian patient. The strain was isolated in 2009 (1 year after the first-described mutant in United States), demonstrating that these alleles were scattered worldwide earlier than previously thought.Fil: Isla, Guillermina. Instituto Nacional de Enfermedades Infecciosas; ArgentinaFil: Leonardelli, Florencia. Universidad Nacional del Litoral; ArgentinaFil: Tiraboschi, Iris Nora. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Refojo, Nicolás. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Hevia, Alejandra. Instituto Nacional de Enfermedades Infecciosas; ArgentinaFil: Vivot, Walter Oscar. Instituto Nacional de Enfermedades Infecciosas; ArgentinaFil: Szusz, Wanda. Instituto Nacional de Enfermedades Infecciosas; ArgentinaFil: Córdoba, Susana Beatríz. Instituto Nacional de Enfermedades Infecciosas; ArgentinaFil: García Effron, Guillermo. Instituto Nacional de Enfermedades Infecciosas; Argentin

Recommendations for the management of candidemia in children in Latin America

Candidemia is one of the most frequent opportunistic mycoses worldwide. Limited epidemiological studies in Latin America indicate that incidence rates are higher in this region than in the Northern Hemisphere. Diagnosis is often made late in the infection, affecting the initiation of antifungal therapy. A more scientific approach, based on specific parameters, for diagnosis and management of candidemia in Latin America is warranted.'Recommendations for the diagnosis and management of candidemia' are a series of manuscripts that have been developed by members of the Latin America Invasive Mycosis Network. They aim to provide a set of best-evidence recommendations for the diagnosis and management of candidemia.This publication, 'Recommendations for the management of candidemia in children in Latin America', was written to provide guidance to healthcare professionals on the management of children who have, or who are at risk of, candidemia.Computerized searches of existing literature were performed by PubMed. the data were extensively reviewed and analyzed by members of the group. the group also met on two occasions to pose questions, discuss conflicting views, and deliberate on a series of management recommendations.'Recommendations for the management of candidemia in children in Latin America' includes prophylaxis, empirical therapy, therapy for proven candidemia, patient work-up following diagnosis of candidemia, duration of candidemia treatment, and central venous catheter management in children with candidemia. This manuscript is the third of this series that deals with diagnosis and treatment of invasive candidiasis. Other publications in this series include: 'Recommendations for the diagnosis of candidemia in Latin America', 'Recommendations for the management of candidemia in adults in Latin America', and 'Recommendations for the management of candidemia in neonates in Latin America'.This article is also published in Spanish in this issue. It can be found in http://dx.doi.org/10.1016/j.riam.2013.05.011(c) 2013 Revista lberoamericana de Micologia. Published by Elsevier Espana, S.L. All rights reserved.PfizerUniv Chile, Hosp Luis Calvo Mackenna, Santiago, ChileUniv Fed Parana, Hosp Clin, BR-80060000 Curitiba, Parana, BrazilHosp Escuela Tegucigalpa, Tegucigalpa, HondurasUniversidade Federal de São Paulo, São Paulo, BrazilPontificia Univ Catolica Ecuador, Hosp Vozandes, Fac Med, Quito, EcuadorUniv Buenos Aires, Hosp Clin Jose de San Martin, Buenos Aires, DF, ArgentinaUniv Nacl Colombia, Bogota, ColombiaUniv Desarrollo, Clin Alemana, Santiago, ChileHosp Privado, Ctr Med Caracas, Caracas, VenezuelaNatl Inst Med Sci & Nutr, Tlalpan, MexicoUniv Peruana Cayetano Heredia, Lima, PeruUniv Fed Rio de Janeiro, Rio de Janeiro, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Recommendations for the management of candidemia in neonates in Latin America

Candidemia is one of the most frequent opportunistic mycoses worldwide. Limited epidemiological studies in Latin America indicate that incidence rates are higher in this region than in the Northern Hemisphere. Diagnosis is often made late in the infection, affecting the initiation of antifungal therapy. A more scientific approach, based on specific parameters, for diagnosis and management of candidemia in Latin America is warranted.'Recommendations for the diagnosis and management of candidemia' are a series of manuscripts that have been developed by members of the Latin America Invasive Mycosis Network. They aim to provide a set of best-evidence recommendations for the diagnosis and management of candidemia.This publication, 'Recommendations for the management of candidemia in neonates in Latin America', was written to provide guidance to healthcare professionals on the management of neonates who have, or who are at risk of, candidemia.Computerized searches of existing literature were performed by PubMed. the data were extensively reviewed and analyzed by members of the group. the group also met on two occasions to pose questions, discuss conflicting views, and deliberate on a series of management recommendations.'Recommendations for the management of candidemia in neonates in Latin America' includes prophylaxis, empirical therapy, therapy for proven candidemia, patient work-up following diagnosis of candidemia, central venous catheter management, and management of complications.This manuscript is the fourth of this series that deals with diagnosis and treatment of invasive candidiasis. Other publications in this series include: 'Recommendations for the diagnosis of candidemia in Latin America', 'Recommendations for the management of candidemia in adults in Latin America', and 'Recommendations for the management of candidemia in children in Latin America'.This article is also published in Spanish in this issue. It can be found in http://dx.doi.org/10.1016/j.riam.2013.06.002(c) 2013 Revista lberoamericana de Micologia. Published by Elsevier Espana, S.L. All rights reserved.PfizerUniv Chile, Hosp Luis Calvo Mackenna, Santiago, ChileHosp Escuela Tegucigalpa, Tegucigalpa, HondurasUniv Fed Parana, Hosp Clin, BR-80060000 Curitiba, Parana, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilPontificia Univ Catolica Ecuador, Hosp Vozandes, Fac Med, Quito, EcuadorUniv Buenos Aires, Hosp Clin Jose de San Martin, Buenos Aires, DF, ArgentinaUniv Nacl Colombia, Bogota, ColombiaUniv Desarrollo, Clin Alemana, Santiago, ChileHosp Privado, Ctr Med Caracas, Caracas, VenezuelaNatl Inst Med Sci & Nutr, Tlalpan, MexicoUniv Peruana Cayetano Heredia, Lima, PeruUniv Fed Rio de Janeiro, Rio de Janeiro, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc