Ocorrência de infecções de corrente sanguínea por Pichia anomala em hospital terciário de São José do Rio Preto - SP

Abstract

Bloodstream Infections caused by Pichia anomala are rare. From October 2003 to December 2004, 29 cases of fungemia by Pichia anomala were identified in a Tertiary Hospital, Hospital de Base de São José do Rio Preto - São Paulo. Objective: To evaluate cases of Pichia anomala fungemia in pediatric patients of this Institution. Methods: 29 cases of bloodstream infections were identified by Pichia anomala and they were evaluated by systematically reviewing the medical patients records. There were collected demographic information, basic clinical conditions, concomitant medications, previous antifungal treatments. Clinical information on the evolution of patients by the end of hospitalization or death were also analyzed. Species identification and antifungal susceptibility tests was done in the Laboratório Especial de Micologia of the Universidade Federal de São Paulo by the broth microdilution method. Results: The incidence of fungemia by Pichia anomala was 6.46 cases per 1000 admissions. The average age of the patients was 1.7 years, whith 13 neonatal cases. The average length of hospital stay was 12.7 days, 25 cases (86.2%) were admitted to intensive care units. Regarding neonatal cases, premature were the vast majority (81.8%) and birth weight was 1788,6g. Several other patient characteristics may be considered as risk factors for the onset of fungemia by Pichia anomala as prolonged hospital stay, presence of neoplastic disease, surgery, mechanical ventilation, use of parenteral nutrition, presence of central venous catheters, use of antibiotics and use of corticosteroids. Twenty-three patients (79.3%) were treated with antifungals and nineteen patients (65%) died within thirty days after the first episode of fungemia. There was no strain resistant or with intermediate sensitivity to agents tested. Fourteen strains (36.8%) with dose-dependent sensitivity to itraconazole and one strain (2.6%) with dose-dependent sensitivity to both fluconazole and itraconazole were found.