A first Portuguese epidemiological survey of fungaemia in a university hospital

A prospective, observational study was conducted at the biggest Portuguese hospital, aiming to evaluate the epidemiology of bloodstream fungal infection. During a period of 12 months (2004), all yeasts isolated from the blood cultures of patients with fungaemia admitted at a university hospital of Porto were collected. Demographic and clinical data, as well as haematological and biochemical profiles, were registered. Antifungal susceptibility was evaluated. The incidence of fungaemia and nosocomial fungaemia were 2.7 and 2 per 1,000 hospital admissions, respectively. Blood strains from 117 patients were identified. Thirty-five percent of yeast isolates were Candida albicans, followed by C. parapsilosis (25.6%). The mortality rate associated with fungaemia was 39.3%; the highest values were found in patients with C. glabrata and C. tropicalis infection. Seventy-five percent of the fungaemia episodes were nosocomial, with 48% mortality; the main predisposing factors were parenteral nutrition, gastric protection with omeprazole, surgical drainage and the presence of central venous catheters (CVCs). Thrombocytopaenia, urinary catheter, gastrointestinal pathology and nosocomial fungaemia were independently associated with a poor outcome. Antifungal susceptibility testing showed high fluconazole resistance (15%), mostly in C. tropicalis. We observed a high incidence of nosocomial fungaemia with high mortality rates. Important predisposing factors were identified, deserving further investigation. Local surveillance is warranted to monitor the incidence of in vitro antifungal resistance.