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Multicenter Study
. 2017 Apr 18;12(4):e0175172.
doi: 10.1371/journal.pone.0175172. eCollection 2017.

A multi-centric Study of Candida bloodstream infection in Lima-Callao, Peru: Species distribution, antifungal resistance and clinical outcomes

Lourdes Rodriguez  1 , Beatriz Bustamante  2 , Luz Huaroto  3 , Cecilia Agurto  4 , Ricardo Illescas  1 , Rafael Ramirez  1 , Alberto Diaz  1 , Jose Hidalgo  1
Affiliations
Multicenter Study

A multi-centric Study of Candida bloodstream infection in Lima-Callao, Peru: Species distribution, antifungal resistance and clinical outcomes

Lourdes Rodriguez et al. PLoS One. .

Abstract

Background: 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.

Methods: 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.

Results: 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%).

Conclusions: 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.

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Conflict of interest statement

Competing Interests: After completing the data collection period in January 2015, one of the authors (Lourdes Rodriguez-Piazze from Hospital Almenara) stopped working at the hospital and became part of the staff of Merck Sharp Dohme in Lima, Peru as an Associate Medical Director. This study did not involve the use or evaluation of any drug, therefore the current position of this author does not compromise data integrity or analysis of the findings, and is in compliance with the PLOS Policy on Declaration and Evaluation of Competing Interests. No other competing interests are to be reported for the other authors.

Figures

Fig 1
Fig 1. 30-day survival curve by treatment of candidemia (RR vs. days).
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