Epidemiology and Outcomes of Invasive Candidiasis Due to Non-albicans Species of Candida in 2,496 Patients: Data from the Prospective Antifungal Therapy (PATH) Registry 2004–2008

Abstract

This analysis describes the epidemiology and outcomes of invasive candidiasis caused by non-albicans species of Candida in patients enrolled in the Prospective Antifungal Therapy Alliance (PATH Alliance) registry from 2004 to 2008. A total of 2,496 patients with non-albicans species of Candida isolates were identified. The identified species were C. glabrata (46.4%), C. parapsilosis (24.7%), C. tropicalis (13.9%), C. krusei (5.5%), C. lusitaniae (1.6%), C. dubliniensis (1.5%) and C. guilliermondii (0.4%); 111 infections involved two or more species of Candida (4.4%). Non-albicans species accounted for more than 50% of all cases of invasive candidiasis in 15 of the 24 sites (62.5%) that contributed more than one case to the survey. Among solid organ transplant recipients, patients with non-transplant surgery, and patients with solid tumors, the most prevalent non-albicans species was C. glabrata at 63.7%, 48.0%, and 53.8%, respectively. In 1,883 patients receiving antifungal therapy on day 3, fluconazole (30.5%) and echinocandins (47.5%) were the most frequently administered monotherapies. Among the 15 reported species, 90-day survival was highest for patients infected with either C. parapsilosis (70.7%) or C. lusitaniae (74.5%) and lowest for patients infected with an unknown species (46.7%) or two or more species (53.2%). In conclusion, this study expands the current knowledge of the epidemiology and outcomes of invasive candidiasis caused by non-albicans species of Candida in North America. The variability in species distribution in these centers underscores the importance of local epidemiology in guiding the selection of antifungal therapy.

Microevolution of <i>Candida albicans</i> Isolate from a Patient with Mucocutaneous Candidiasis and HIV Infection

“…Mucocutaneous candidiasis, including oropharyngeal, oesophageal, and vulvovaginal forms, produced by C. albicans is the most common fungal infection in individuals with HIV [5]; however, the involvement of other Candida species has also been reported [3]. In this study, PCR-RFLP analysis of the 5.8S-ITS region clearly demonstrated C. albicans infection in the three analysed clinical samples.…”

“…as an important cause of morbidity and mortality in hospitalised patients [2]. Candidiasis is caused mainly by C. albicans, but other species such as Candida glabrata, Candida krusei, Candida tropicalis, Candida parapsilosis, and Candida dubliniensis have also been isolated singly and at low frequency (1.6% -6%) in combination with C. albicans [3]. Therefore, the proper identification of the Candida species is important for choosing the appropriate therapy, as different Candida spp.…”

“…Therefore, the proper identification of the Candida species is important for choosing the appropriate therapy, as different Candida spp. display different antifungal drug susceptibilities [3] [4]. Biochemical identification of Candida spp.…”

A new multiplex PCR for species-specific diagnosis of human candidiasis

“…La etiología de estas infecciones se ha asociado con más de 17 especies, siendo Candida albicans la de mayor relevancia epidemiológica, pues se la relaciona con, aproximadamente, 50 % de los casos de infecciones profundas provocadas por Candida spp. (3,4). Sin embargo, en las últimas décadas, el conglomerado de especies diferentes a C. albicans ha emergido como patógeno principal en la etiología de la candidiasis sistémica (5-7).…”

“…En este contexto, este trabajo tuvo como objetivo diseñar un ensayo de PCR múltiple fundamentado en secuencias blanco específicas para las cinco especies del género Candida de mayor relevancia a nivel hospitalario: C. albicans, C. guillermondii, C. tropicalis, C. parasilopsis y C. krusei (4,7). El diseño de las secuencias cebadoras se hizo con ayuda de programas de bioinformática de acceso libre (Gene Runner TM , http://www.generunner.net/) y algoritmos de optimización de secuencias cebadoras para ensayos de PCR múltiple (Mult-PSOS) (16).…”