Caracterização clínica e epidemiológica das infecções de corrente sanguínea causadas por Candida spp. no Hospital São Paulo

• Ano de defesa: 2010
• Autor(a) principal: Wille, Marcos Paulo [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Epidemiologia; Infecção da corrente sangüínea; Candida; Candidíase
• Link de acesso: http://repositorio.unifesp.br/handle/11600/9163

Among the invasive infections caused by the genus Candida, it is worthwhile to emphasize the clinical relevance of bloodstream infections (BSIs), namely hematogenous candidiasis or candidemia. The hematogenous candidíases is a severe infection which has a high prevalence in medical centers worldwide. The aim of this study is to analyze the evolution of incidence rates of candidemia during the period of 11 years and to evaluate the possible changes in the epidemiological profile of patients with candidemia admitted at the São Paulo Hospital along the 2 periods: 1994-1999 versus 2000-2004. This is a retrospective study developed from a transversal cohort, with data collected prospectively for determination of epidemiological and microbiological features from episodes of candidemia in patients admitted at the São Paulo Hospital during the period of June 1994 to December 2004. The clinical and epidemiological informations by reviewing medical records and were recorded in standard case report form. Candidemia was defined as at least one positive blood culture for Candida sp. after proper antisepsis, being only the first episode of candidemia considered for characterization of clinical cases. The characterization of microbial strains was performed in a single laboratory (LEMI – UNIFESP) by conventional methods. Antifungal susceptibility tests were performed using the broth micro dilution assay according to the methodology by the Clinical and Laboratory Standards Institute (CLSI). All data were stored in database and statistical analysis was performed by SPSS version 15.0 and EPI-INFO version 6.0. We analyzed a total of 388 episodes of BSIs caused by Candida spp, and the prevalence of infection was mainly observed in young adults population (> 14 years-old), which accounted for 61.1% (237/388) from all cases, and 60.3% (234) were male. Candida non-albicans species corresponded to 57.6% (223/388) of the casuistic, being C. tropicalis and isolates of the C. parapsilosis complex the most prevalent species observed along the period studied. In the second study period candidemia was more frequently observed in the elderly population, heart disease, lung disease, liver disease and kidney failure. On the other hand, there was a higher prevalence of neurologic disease and non-fungal infectious syndrome in the second study period. At this time, the major occurrence of degenerative diseases in the individuals indicates more prevalence of these diseases in the elderly. We observed a substantial number of patients about 30% which did not have opportunity to treat with antifungal drugs. The overall mortality documented was 55.4%, with no changes along the period studied. We could demonstrate during the 11 years that there were no significant changes in the incidence of candidemia at the São Paulo Hospital, neither in the pattern of Candida species distribution. In the contrast, we observed a clear tendency of high prevalence of candidemia in young adults and in the elderly populations along the second period, with more records of this infectious disease in individuals with more comorbities.