14th ICID - Poster Abstracts - International Society for Infectious ...

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When citing these abstracts please use the following reference: Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number. Please note that the official publication of the International Journal of Infectious Diseases 2010, Volume 14, Supplement 1 is available electronically on http://www.sciencedirect.com Final Abstract Number: 30.019 Session: Mycology, Fungal Infections and Antifungal Drugs Date: Wednesday, March 10, 2010 Time: 12:30-13:30 Room: Poster & Exhibition Area/Ground Level Type: Poster Presentation Risk factors for candidemia-related mortality in a Neonatal Intensive Care Unit (NICU) C. I. Echave, M. L. PRAINO, M. L. Vozza, C. Manso, M. Russman, C. Enfedaque, A. Martinez Burkett, A. Procopio, N. Rivas, E. L. Lopez Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina Background: Candidemia is related to significant morbidity and mortality, specially in infants at the NICU. The aim of this study was to identify the risk factors for mortality among these patients Methods: We retrospectively studied all the patients with positive blood cultures for Candida spp. treated in NICU between, January 2003 and December 2008, at the Hospital de Niños “Ricardo Gutierrez” in Buenos Aires, Argentina. We analyzed the clinical baseline characteristics and risk factors for mortality: persistence of positive blood cultures, days to central venous catheter (CVC) removal, underlying diseases, secondary compromised organs and species of Candida Results: During the study period a total of 20 patients were identified. However, 2 patients were excluded, due to insufficient data in the medical records. Ten patients were male (55%); age: median 40 days (range 7-117 ds). All patients were admitted to the NICU, immediately after birth. None of them was less than 28 weeks gestation. The weight at birth was less than 1500g in only one patient. The most frequent underlying disease was surgical pathology of the gastrointestinal tract (9/18, 50%). Most of the patients had risk factors for candidemia as CVC (14/18, 77,7%), parenteral nutrition (15/18, 83%) and previous use of broad spectrum antibiotics (100%). Candida albicans resulted the main agent (9/19, 47%). One patient had two different species of Candida: albicans and tropicalis. The global mortality rate was 27.7% (5/18). Mortality was associated with: later removal of catheter, mean 1.9 ds vs. 5.8ds, (p= 0.02) and days to first negative blood culture: mean 4.36 ds vs. 9 ds (p= 0.025), in survivors vs patients who died, respectively Conclusion: The high mortality rate by Candida in our setting was similar to the reported by the literature. Candida albicans remained the most common isolated specie. Mortality was statistically significant related to persistent candidemia and the delay to remove CVC.
When citing these abstracts please use the following reference: Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number. Please note that the official publication of the International Journal of Infectious Diseases 2010, Volume 14, Supplement 1 is available electronically on http://www.sciencedirect.com Final Abstract Number: 30.020 Session: Mycology, Fungal Infections and Antifungal Drugs Date: Wednesday, March 10, 2010 Time: 12:30-13:30 Room: Poster & Exhibition Area/Ground Level Type: Poster Presentation Analysis of candidemia epidemiological data and antifungigram by distinct methodologies in a large Brazilian teaching hospital A. Motta 1 , G. D. Almeida 2 , J. N. Almeida JR 3 , M. I. Pinto 1 , M. N. Burattini 4 , F. ROSSI 5 1 Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 2 Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil, 3 Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil, 4 Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, 5 Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SAO PAULO, SP, Brazil Background: Candidemia results in substantial morbidity and mortality and species distribution and its susceptibility profile should be locally monitored. Antifungigram still a challenge but few laboratories have microdilution techniques in Latin America, in a routine basis, and other methodologies should be evaluated. Methods: Epidemiological data from candidemia episodes were collected during 2006 in a large teaching hospital. Incidence was calculated by 1,000 admission and 1,000 patient days. Minimal inhibitory concentrations (MIC) were determined using Sensititre Yeast-One Y8, and E-test. The following drugs were tested: amphotericin B (AMB); caspofungin (CAS); posaconazole (POS), fluconazole (FLU), Itraconazol (ITRA) and voriconazole (VOR). The disk diffusion method was also performed for FLU and VOR according to CLSI. Results: One hundred and thirty-six cases of candidemia were identified and represented 3.5% of the overall positive blood cultures. Incidence was 1.87 cases per 1,000 admissions and 0.27 cases per 1,000 patient-days. 58.1% patients were male and the median age was 40 years old being cancer the most frequent associated underlying disease. C. albicans (52. 2%), followed by C. parapsilosis (22.1%), C. tropicalis (14.8%) and C. glabrata (6.6%) were the more frequent species. Among 100 isolates viable for susceptibility tests 100% were susceptible to AMB (MIC 90 = 1.0 mg/L) and CAS (MIC 90 = 0.064 mg/L); 98 % to VOR (MIC 90 = 0.008 mg/L); 91% to FLU (MIC90 = 0.5 mg/L) ; and 66% to ITRA (MIC 90= 0.125 mg/L). Posaconazole MIC90was 0.032 mg/mL. The percentage of essential agreement (EA) and categorical agreement (CA) between broth micro dilution and other methodologies were > 93%, except for itraconazole (EA 80%, CA 70%). CA between Sensititre Yeast-One versus disk diffusion and E-test versus disk diffusion for FLU were respectively: (94%; 95%) and for VOR( 96% ,98%). Minor errors accounted for the majority of categorical errors. Conclusion: Candidemia by C. albicans still the majority of episodes in our Hospital but nonalbicans C species are a growing problem and its susceptibility should be closed monitored even though overall resistance still very low. Disk diffusion and E-test had good CA and may be an alternative methodology for routine Latin America laboratories.
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