Epidemiology and treatment of hematogenous candidiasis: a Brazilian perspective

Hematogenous candidemia is an increasingly frequent problem among patients who are immunosuppressed, receiving parenteral nutrition and/or antibiotics, or who have invasive medical devices such as indwelling catheters. In Brazil, Candida albicans was responsible for 53/145 (37%) of candidemia in 6 different tertiary care hospitals. The most common non-albicans species were C. parasilosis (25%), C. tropicalis (24%), C. rugosa (5%) and C. glabrata (4%). The main risk factors for infection were antibiotic use and the presence of a central venous catheter. The main risk factors for mortality were patient age (older patients at risk) and not removing the catheter. Because of the great number of non-albicans species and varied degrees of antifungal drug sensitivity, laboratory identification and sensitivity testing is very important. All patients with documented candidemia should be treated. Drugs to be used are amphotericin B and/or fluconazole. Fluconazole resistance is not yet a problem in Brazil, perhaps because it is rarely used as prophylaxis due to its high cost. Intravenous catheters should be removed immediately if the patient has a short term catheter, or if the patient is clinically unstable due to the infection and has a long term catheter in place.