Eight-Year Surveillance of Non-Albicans Candida spp. in an Oncology Department Prior to and After Fluconazole Had Been Introduced into Antifungal Prophylaxis

Abstract

From 1989 until 1996, during the last 8 years, the proportion of Candida (C.) krusei, and other non-albicans Candida spp. isolated from surveillance cultures and from sterile body sites, was analyzed among 13,758 admissions in a National Cancer Institute. During these admissions a total of 9,042 isolates were prospectively collected from surveillance cultures, and 126 from blood cultures. The proportion of C. krusei among all organisms was 12.7% to 16.5% in 1989 through 1991, i.e., before fluconazole was introduced into prophylactic protocols. After the introduction of fluconazole into prophylaxis in acute leukemia in 1992 the incidence of C. krusei was 7.9% to 8.6% during 1994 to 1996. After 5 years of using this drug for prophylaxis, the incidence of C. krusei was lower than before this drug was introduced in our institute. Among yeasts, the most frequently isolated pathogen was still Candida albicans (72.2% of all isolated fungal organisms). Among molds, Aspergillus spp. was the most frequently isolated agent. Analyzing the etiology of proven fungal infections (fungemias) confirmed by positive blood cultures, C. albicans was the most common causative organism in 53.8% of cases. The incidence of fungemia due to Torulopsis (C.) glabrata and C. krusei before and after fluconazole introduction did not change. Of 126 organisms isolated from blood cultures, there was no increase in T. (C.) glabrata or C. krusei after introduction of fluconazole for prophylaxis and therapy, and the quoted 6.4% of fungemic episodes remained stable with an incidence of 1 fungemia/year since 1991. The proportion of C. krusei and C. glabrata among Candida spp. was decreasing in our center between 1989 and 1996. Also, the proportion of non-albicans Candida spp. among isolates decreased from 25.7% in 1990 to 11.9% in 1996.

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

“…Multiple studies have suggested that the use of azoles can drive the species distribution within a population toward species with intrinsic resistance (1,8,10,16,26,33,34). Still, other factors may be contributing to this change in species distribution (27,32), and a few studies have shown no increase in the incidence of azole-resistant Candida species following azole prophylaxis (14,29). At least one report recorded an increase in C. krusei among immunocompromised patients who had not been treated with fluconazole (11).…”

Candida krusei , a Multidrug-Resistant Opportunistic Fungal Pathogen: Geographic and Temporal Trends from the ARTEMIS DISK Antifungal Surveillance Program, 2001 to 2005

“…Whether this observation is a direct result of fluconazole administration remains controversial, since others have reported infections due to this species before the introduction of fluconazole (14,22,60). In addition, several centers have reported no increased incidence of infections with C. krusei, despite the widespread use of fluconazole (8,17,18,51,55). As reported in several smaller studies (5, 6, 10, 23, 30, 34, 37, 39, 55), C. krusei was generally susceptible to voriconazole, although considerable geographic differences were seen (Table 1), like those seen with C. glabrata (49) and Candida rugosa (46).…”

Antimicrobial Resistance and Implications for the Twenty-First Century

“…For example, C. glabrata was seen to rise in prevalence in a French institution where amphotericin B, not fluconazole, is routinely used for antifungal prophylaxis (Sanglard and Odds, 2002). Other studies have shown that introduction of routine fluconazole prophylaxis was followed by a reduction in the prevalence of C. glabrata and C. krusei (Baran et al, 2001;Kunova et al, 1997). Taken together, these data suggest that multiple factors are driving the changing species distribution including (1) host factors such as underlying disease and immunocompetence, (2) antifungal prophylaxis practices, (3) antibacterial use, and (4) immunosuppressive regimens (Sanglard and Odds, 2002).…”