New echinocandin susceptibility patterns for nosocomial Candida albicans in Bogotá, Colombia, in ten tertiary care centres: an observational study

BMC Infectious Diseases

Research Article

Katrien Lagrou¹  María Antonia Gaona²  Arley Gómez-López³  Milciades Ibáñez⁴  Manuel Alfonso Patarroyo⁵  Giovanni Rodríguez-Leguizamón⁶  Alessandro Fiori⁷  Patrick Van Dijck⁷ 

[1] Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium;Faculty of Natural and Mathematical Sciences, Universidad del Rosario, Bogotá, Colombia;Molecular Biology and Immunology Department, Fundación Instituto de Inmunología de Colombia (FIDIC), Carrera 50#26-20, Bogotá, Colombia;School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia;School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia;Molecular Biology and Immunology Department, Fundación Instituto de Inmunología de Colombia (FIDIC), Carrera 50#26-20, Bogotá, Colombia;School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia;VIB Department of Molecular Microbiology, KU Leuven, Leuven, Belgium;KU Leuven Laboratory of Molecular Cell Biology, Leuven, Belgium;VIB Department of Molecular Microbiology, KU Leuven, Leuven, Belgium;KU Leuven Laboratory of Molecular Cell Biology, Leuven, Belgium;

关键词: Candida albicans;    Nosocomial infection;    Susceptibility;    Echinocandins;    Resistance;   

DOI  :  10.1186/s12879-015-0840-0

 received in 2015-01-16, accepted in 2015-02-18,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundCandida albicans remains as the first cause of nosocomial fungal infections in hospitals worldwide and its susceptibility pattern should be better described in our tertiary care hospitals.MethodsThis study aimed at identifying the caspofungin susceptibility pattern regarding nosocomial Candida albicans infection in ten tertiary care hospitals using the methodology proposed by CLSI M27-A3 and CLSI M27-S4, and its association with risk factors and clinical outcome. The approach involved descriptive research concerning the diagnosis of nosocomial infection during a 7-month period in 10 hospitals in Bogotá, Colombia. Associations were established using exact non-parametric statistical tests having a high statistical power (>95%), suitable for small samples. The exact Mann Whitney test or Kruskall-Wallis non-parametric ANOVA tests were used for distributions which were different to normal or ordinal variables when comparing three or more groups. Multivariate analysis involved using binomial, multinomial and ordinal exact logistical regression models (hierarchical) and discrimination power was evaluated using area under the ROC curve.Results101 nosocomial infections were found in 82,967 discharges, for a Candida spp. infection rate of 12.2 per 10,000 discharges, 30.7% caused by C. albicans, 22.8% by C. tropicalis, 20.8% by C. parapsilosis, 19.8% by other Candida, 3% by C. krusei and 3% by C. glabrata. Statistically significant associations between mortality rate and the absence of parenteral nutrition were found in multivariate analysis (OR = 39.746: 1.794-880.593 95% CI: p = 0.020). The model’s predictive power was 83.9%, having an 85.9% significant prediction area (69.5%-100 95% CI; p = 0.001).ConclusionsSignificant differences were found regarding susceptibility results when comparing CLSI M27-A3 to CLSI M27-S4 when shifting clinical break-point values. However, one nosocomial strain was consistent in having reduced susceptibility when using both guidelines without having been directly exposed to echinocandins beforehand and no mutations were found in the FKS1 gene for hot spot 1 and/or hot spot 2 regions, thereby highlighting selective pressure regarding widespread antifungal use in tertiary healthcare centres. Nutritional conditions and low family income were seen to have a negative effect on survival rates.

【 授权许可】

Unknown   
© Rodríguez-Leguizamón et al.; licensee BioMed Central. 2015. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.