Candida albicansand non-Candida albicansfungemia in an institutional hospital during a decade

Abstract

Since the outcomes of patients with candidemia is poor and Candida spp. with increased resistance to antifungal therapy may be associated with these results, the emergence of these blood infections caused by non-C. albicans Candida spp. was explored prospectively over a two-year period (2009-2010). Candidemia was defined as the recovery of Candida spp. in culture from a patient's blood sample. The in vitro susceptibility of each isolate to amphotericin B, caspofungin, fluconazole and voriconazole was determined. In addition, characteristics of patients and outcomes were investigated in real-time. The Candida distribution was compared to that observed in a similar study 10 years earlier in the same hospital. A total of 182 patients with candidemia were included in the study. While C. albicans was the most frequently isolated species (n = 102), non-C. albicans Candida spp. included; C. glabrata (n = 32), C. parapsilosis (n = 21), C. tropicalis (n = 13), C. krusei (n = 8), C. kefyr (n = 3), C. lusitaniae (n = 2), C. lipolytica (n = 2), C. famata (n = 1), C. guilliermondii (n = 1), C. inconspicua (n = 1), C. dubliniensis (n = 1), C. sake (n = 1) and C. nivariensis (n = 1). In seven patients, C. albicans was associated with another Candida spp. Surprisingly, this prospective study demonstrated that regardless of the department (intensive care unit or hematological department), Candida spp. distribution was no different from that found in the 1998-2001 survey, except for C. krusei. A reduction in the proportion of C. krusei isolates was observed from 2000-2010 (P = 0.028) as a result of its decreased recovery in the hematological department.

Epidemiology, species distribution and outcome of nosocomial Candida spp.bloodstream infection in Shanghai

“…Of note, our study showed that presence of sepsis symptoms was predominant in patients infected with C. albicans (88.9%), C. tropicalis (94.4%), C. guilliermondii (85.7%) and C. sake (83.3%) rather than in patients infected by other Candida species (44.4%-60.0%). Interestingly, we observed in the present study that C. guilliermondii and C. sake represented 5.8% and 5.0% of the isolates; while only 0.2%-2.4% of C. guilliermondii was observed in European countries [11,18,41,42], in Taiwan [43] and in Latin America except in Honduras (20%) [33]. The emergence of severe sepsis due to C. sake is here remarkable, knowing that the latter species represented only 0.03% of isolates in a recent publication from ARTEMIS [44].…”

Epidemiology of Candida kefyr in Patients with Hematologic Malignancies

“…Colonization and infection follow a seasonal distribution, with higher rates during the warm months of the year. Our understanding of the epidemiology of C. kefyr has been limited, derived mainly from case reports (12,27,28), laboratorybased analyses (13)(14)(15)(29)(30)(31)(32)(33)(34), and large surveillance registries (11). This body of evidence has suggested that HM patients may be a high-risk group for infection with this organism, albeit C. kefyr is a rare cause of invasive disease.…”

Rapid Emergence of Echinocandin Resistance during Candida kefyr Fungemia Treatment with Caspofungin

“…Therefore, the surveillance of the susceptibility to echinocandin of this relatively scarce species, responsible for Ͻ1% to 1.6% of cases of candidemia (13,14), may be of interest. Awaiting other reports of such rapid resistance emergence, we suggest closer monitoring of C. kefyr in patients treated with echinocandins.…”