Current trends in candidemia and species distribution among adults: Candida glabrata surpasses C. albicans in diabetic patients and abdominal sources

Abstract

Candidemia rate and species distribution vary according to the type of patients, country of origin and antifungal prophylaxis use. To present current candidemia epidemiological trends. A retrospective examination of candidemia in adults (≥18 years-old) hospitalised from 2007 to 2015. Cases were identified through the microbiology laboratory. Candida species were distinguished based on colony morphology and VITEK-2 YBC cards, (bioMerieux, Durham, NC, USA). Patient characteristics, species distribution, source and outcome were assessed. We encountered 275 patients (294 episodes) with candidemia. The rate of candidemia dropped in 2010 (P = 0.003) without further decline. Nearly all cases (97.5%) were healthcare-associated. C. albicans (n = 118) and C. glabrata (n = 77) proportions varied without a discernable trend. C. glabrata was more common in diabetics [52.9% vs. 32.0% (non-diabetics); P = 0.004] and abdominal sources [53.3% vs. 35.5% (other sources); P = 0.03], especially gastric/duodenal foci [88.9% vs. 44.1% (other abdominal foci); P = 0.02]. All-cause 30-day mortality rate was 43.3% without changes over time or differences between C. albicans and C. glabrata. In conclusion, the candidemia rate remains stable after a decline in 2010. C. albicans remains the most common species but C. glabrata predominates in diabetics and abdominal sources. These findings suggest possible species-related differences in colonisation dynamics or pathogenicity.

Candida glabrata Transcription Factor Rpn4 Mediates Fluconazole Resistance through Regulation of Ergosterol Biosynthesis and Plasma Membrane Permeability

“…They are responsible for localized superficial infections in healthy individuals but can cause life-threatening scenarios in immunocompromised patients. The ability to rapidly acquire azole resistance has been associated with the increased prevalence of Candida glabrata relative to the most commonly isolated species, C. albicans ( 1 , 4 – 9 ). C. glabrata now ranks as the second or third most prevalent Candida species, depending on geographical location.…”

Candida glabrata’s Genome Plasticity Confers a Unique Pattern of Expressed Cell Wall Proteins

“…Candidemias have remained stable over the last decade but several studies report decreasing frequency of C. albicans and increases of other non- albicans species. Among these species, C. glabrata is of particular concern since it is innately less susceptible to azoles [ 4 , 5 ]. Alarmingly, some studies have found resistance to echinocandin class of antifungals among the already azole resistant C. glabrata clinical isolates in the US [ 6 ].…”

Synergistic and antagonistic effects of immunomodulatory drugs on the action of antifungals againstCandida glabrataandSaccharomyces cerevisiae

“…The most vulnerable populations include transplant patients, patients with AIDS or cancer, those on immunosuppressive therapy, patients receiving total parenteral nutrition, and premature infants ( Pfaller & Diekema, 2010 ; Whaley & Rogers, 2016 ). In certain populations, C. glabrata even surpasses C. albicans as the leading pathogen; these include patients with hematologic malignancies, diabetes mellitus, and patients with an abdominal source of infection ( Hachem et al, 2008 ; Segireddy et al, 2011 ; Khatib et al, 2016 ; Whaley & Rogers, 2016 ). The reasons for the rise of C. glabrata infections include the introduction of fluconazole in 1990 and its widespread prophylactic use against fungal infections ( Berrouane, Herwaldt & Pfaller, 1999 ), a higher rate of antifungal use and intrinsic or acquired resistance of C. glabrata to both fluconazole and echinocandins ( Silva et al, 2012 ; Pfaller et al, 2012a ; Alexander et al, 2013 ; Pfaller & Castanheira, 2016 ; Colombo, Júnior & Guinea, 2017 ), and better identification of non- albicans species in the clinic ( Liguori et al, 2009 ).…”