| Autor: |
Agnelli C; Division of Infectious Diseases, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil., Guimarães T; Hospital do Servidor Público Estadual de São Paulo, São Paulo 04039-000, Brazil., Sukiennik T; Santa Casa de Misericórdia de Porto Alegre, Rio Grande do Sul 90050-170, Brazil., Lima PRP; Division of Infectious Diseases, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil., Salles MJ; Santa Casa de Misericórdia de São Paulo, São Paulo 01221-010, Brazil., Breda GL; Universidade Federal do Paraná, Curitiba 81531-990, Brazil., Queiroz-Telles F; Universidade Federal do Paraná, Curitiba 81531-990, Brazil., Chaves Magri MM; Hospital das Clínicas da Faculdade de Medicina USP (FMUSP), São Paulo 05403-010, Brazil., Mendes AV; Hospital São Rafael, Salvador 41253-190, Brazil., Camargo LFA; Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil., Morales H; Hospital Erasto Gaertner, São Paulo 81520-060, Brazil., de Carvalho Hessel Dias VM; Hospital Nossa Senhora das Graças, Curitiba 80810-040, Brazil., Rossi F; Pathology Department, Laboratório de Microbiologia da Divisão de Laboratório Central, Hospital das Clínicas da Faculdade de Medicina USP (FMUSP), São Paulo 05403-010, Brazil., Colombo AL; Division of Infectious Diseases, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04024-002, Brazil. |
| Abstrakt: |
Candidemia remains a major public health challenge due to its high mortality rates, especially in developing countries. Monitoring epidemiological trends may provide insights for better clinical outcomes. This study aimed to describe trends in the epidemiology, therapeutic practices, and mortality in candidemia through a retrospective comparative analysis between two surveillance cohorts of all candidemic adults at eleven tertiary hospitals in Brazil, from 2010-2011 (Period I) versus 2017-2018 (Period II). A total of 616 cases were diagnosed, with 247 being from Period II. These patients were more likely to have three or more coexisting comorbidities [72 (29.1%) vs. 60 (16.3%), p < 0.001], had a prior history of in-hospital admissions more often [102 (40.3%) vs. 79 (21.4%), p = 0.001], and presented with candidemia earlier after admission, within 15 days (0-328) vs. 19 (0-188), p = 0.01. Echinocandins were more frequently prescribed [102 (41.3%) vs. 50 (13.6%), p = 0.001], but time to antifungal initiation [2 days (0-14) vs. 2 (0-13), p = 0.369] and CVC removal within 48 h [90/185 (48.6%) vs. 148/319 (46.4%), p = 0.644] remained unchanged. Additionally, many patients went untreated in both periods I and II [87 (23.6%) vs. 43 (17.4%), p = 0.07], respectively. Unfortunately, no improvements in mortality rates at 14 days [123 (33.6%) vs. 93 (37.7%), p = 0.343] or at 30 days [188 (51.4%) vs. 120 (48.6%), p = 0.511] were observed. In conclusion, mortality rates remain exceedingly high despite therapeutic advances, probably associated with an increase in patients' complexity and suboptimal therapeutic interventions. Management strategies should be tailored to suit epidemiological changes, expedite diagnosis to reduce the number of untreated eligible patients and guarantee early antifungal initiation and source control. |
