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Master Thesis

Épidémiologie des candidémies au CHU de Bordeaux du 30 avril 2012 au 30 mars 2016

Abstract : This work reports the results of a retrospective epidemiological study of all the episodes of candidemia which occurred at the Bordeaux University Hospital Centre between April 30, 2012 and March 30, 2016. A total of 295 episodes corresponding to 309 isolates of Candida spp and concerning 276 patients was analyzed. The overall incidence is 0.64 episode per 1000 admissions. With 35% of the diagnosed cases, UTI are the most concerned department, while the adult Hematology department only accounts 6.1% of cases. The presence of an intravascular catheter, a broad-spectrum antibiotic therapy, colonization (≥ 2 sites), recent surgery particularly digestive and age ≥ 65 years are the most found risk factors. Candida albicans remains the main specie but 52.43% of the episodes are caused by non-albicans species. Prevalence of C. tropicalis and rare species seems to be increasing. Distribution of species varies significantly depending on the hospitalization service, age, sex and underlying pathology. Although the prevalence of in vitro susceptibility to antifungals is low, 15.6% of C. tropicalis have decreased susceptibility or are resistant to fluconazole, 43.4% of C. glabrata (whom half comes from UTI patients) show cross-resistance to azoles, and 2 of 5 Candida spp resistant to 3 echinocandins from echinocandins pre-exposed patients are also resistant to azoles. Despite the increasing use of echinocandins (prescribed as first-line therapy in 65.66% of episodes) and several recommendations for candidemia management, the overall 30-day mortality rate is 33.3% and is significantly increased in case of advanced age, candidemia with C. glabrata or hospitalization in intensive care unit. Candidemia with C. tropicalis or C. parapsilosis or hospitalization in a medical department is associated with a better prognosis.
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https://dumas.ccsd.cnrs.fr/dumas-01649587
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Monday, November 27, 2017 - 3:55:22 PM
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Xavier Tessier. Épidémiologie des candidémies au CHU de Bordeaux du 30 avril 2012 au 30 mars 2016 . Médecine humaine et pathologie. 2017. ⟨dumas-01649587⟩

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