Comparison of In Vitro Susceptibility Characteristics of Candida Species from Cases of Invasive Candidiasis in Solid Organ and Stem Cell Transplant Recipients: Transplant-Associated Infections Surveillance Network (TRANSNET), 2001 to 2006

Abstract

Invasive fungal infections (IFI) are a major cause of morbidity and mortality among both solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients. Candida is the most common cause of IFI in SOT recipients and the second most common cause of IFI in HSCT recipients. We determined susceptibilities to fluconazole, voriconazole, itraconazole, posaconazole, amphotericin B, and caspofungin for 383 invasive Candida sp. isolates from SOT and HSCT recipients enrolled in the Transplant-Associated Infection Surveillance Network and correlated these results to clinical data. Fluconazole resistance in C. albicans, C. tropicalis, and C. parapsilosis isolates was low (1%), but the high percentage of C. glabrata and C. krusei isolates within this group of patients increased the overall percentage of fluconazole resistance to 16%. Voriconazole resistance was 3% overall but was 8% among C. glabrata isolates. On multivariable analysis, among HSCT recipients fluconazole nonsusceptibility was independently associated with C. glabrata, nonHodgkin's lymphoma, cytomegalovirus (CMV) antigenemia, diabetes active at the time of the IFI, and any prior amphotericin B use; among SOT recipients, fluconazole nonsusceptibility was independently associated with any fluconazole use in the 3 months prior to the IFI, C. glabrata, ganciclovir use in the 3 months prior to the IFI, diabetes acquired since the transplant, and gender.

Antifungal susceptibility profiles of Candida isolates from a prospective survey of invasive fungal infections in Italian intensive care units

“…On the contrary, as reported in other recent surveys (Pfaller et al, 2011b;Arendrup et al, 2011a;Lockhart et al, 2011), we demonstrated that cases of decreased susceptibility to fluconazole were frequent and increasing. Overall, the median rate of cases of fluconazole resistance in the 11 centres reporting at least ten episodes of deep-seated Candida infection was 17.8 %, with proportions of cases ranging from 4.3 to 28.6 %.…”

Effect of Daily Chlorhexidine Bathing on Hospital-Acquired Infection

“…Previous efforts to reduce the incidence of fungemia have relied mostly on systemic antifungal prophylaxis, which can increase the incidence of antifungal resistance among fungal isolates. 22 If our results are confirmed, topical use of chlorhexidine could be added to strategies to prevent fungal infections.…”

Current Epidemiology of Candida Infection

“…The reason for this increase is unknown, but there is speculation that it is due to the widespread use of azoles (to which C. glabrata has decreased susceptibility) for treatment and prophylaxis of fungal infections. As an example, C. glabrata is the most prevalent Candida species among hematopoietic stem cell transplant recipients, a cohort of patients with a very high rate of antifungal prophylaxis (16,30). There is speculation that because of its haploid genome, C. glabrata may be able to develop tolerance or resistance to azoles more easily than other species of Candida.…”