Candida guilliermondii Fungemia in Patients with Hematologic Malignancies

Abstract

The microbiological, clinical, and epidemiological features of most non-Candida albicans Candida species are well known, but much less is known about species such as Candida guilliermondii, an uncommon pathogen causing a variety of deep-seated infections in immunocompromised hosts. To characterize C. guilliermondii fungemia in patients with hematological malignancies and its susceptibility to antifungal drugs, all cases of C. guilliermondii fungemia diagnosed in our department between 1983 and 2005 were retrospectively analyzed and the literature was reviewed. C. guilliermondii caused 29/243 (11.7%) candidemia episodes diagnosed during the study period. Central venous catheters were the documented sources of candidemia in 19/29 episodes (65.5%), and invasive tissue infections were documented in 2 (6.9%). In the remaining eight, the catheter was not removed and the source of the fungemia remained obscure. Seven episodes ended in death, but only one could be attributed to invasive C. guilliermondii infection. Molecular typing data reveal no evidence of common infection sources. Isolates displayed high rates of in vitro susceptibility to amphotericin B (100%), voriconazole (95%), and fluconazole (90%) and lower rates of in vitro susceptibility to flucytosine (86%), itraconazole (76%), and caspofungin (33%). Our literature review confirms that C. guilliermondii is a significantly more frequent cause of candidemia among cancer patients compared with the general hospital population. It accounted for <1% of the total number of Candida bloodstream isolates reported in the articles we reviewed, with higher rates in Europe (1.4%) and Asia (1.8%) compared with North America (0.3%).Non-Candida albicans Candida species have been recognized as emerging pathogens in cancer patients, particularly those with hematological malignancies. Not only are serious infections caused by these yeast species increasing in frequency, but in a number of cases the strains responsible for the infection display tolerance or resistance to antimycotics (13,41,67). The microbiological, clinical, and epidemiological features of Candida parapsilosis, Candida tropicalis, Candida krusei, and Candida glabrata are well known, but much less is known about other non-C. albicans Candida species. The few reports in the literature on Candida guilliermondii infections suggest that they are associated with poor clinical outcomes. This species has caused a variety of deep-seated infections in immunocompromised hosts and, less frequently, intravenous drug users. Like Candida lusitaniae, it is one of the fungal pathogens most likely to display in vitro resistance to amphotericin B and fluconazole (8,19,20,28,33,49,60,63,68). The present study was an attempt to learn more about the clinical characteristics of infections caused by C. guilliermondii and its antifungal susceptibility pattern. All cases of candidemia diagnosed in our department over the past 22 years were retrospectively analyzed to identify the prevalence and clinical features of C. guilliermondii fun...

Candida guilliermondii , an Opportunistic Fungal Pathogen with Decreased Susceptibility to Fluconazole: Geographic and Temporal Trends from the ARTEMIS DISK Antifungal Surveillance Program

“…Recent in vitro survey data confirm the decreased susceptibility of this species to fluconazole, although the numbers of isolates tested were generally small (1,10,12,26,27). Likewise, the MICs of caspofungin, anidulafungin, and micafungin have been observed to be 2-to 16-fold higher for C. guilliermondii than for other species of Candida, with the exception of Candida parapsilosis (4,10,15,18).…”

“…Candida guilliermondii is an uncommon species of Candida that is most often associated with onychomycosis (3) and is rarely seen as a cause of invasive fungal infection (1,2,4,6,10,12,17,25,27). Dick et al (2) previously reported a case of disseminated candidiasis due to C. guilliermondii in which the patient died despite amphotericin B therapy.…”

“…No obvious clinical or environmental source was identified; however, the isolates shared a common randomly primed polymorphic DNA pattern, and nosocomial transmission stopped following a reinforcement of infection control measures. Most recently, Girmenia et al (4) described an increased frequency of candidemia due to Candida guilliermondii (29 of 243 episodes; 11.7%) among patients with hematologic malignancies in an Italian hospital over a 22-year time period. Molecular typing revealed no evidence of a common infection source; however, at least 65% of the 29 episodes were considered to be catheter related.…”

Candida fermentati as a Cause of Persistent Fungemia in a Preterm Neonate Successfully Treated by Combination Therapy with Amphotericin B and Caspofungin

“…In one study conducted under the auspices of the ARTEMIS DISK Antifungal Susceptibility Program, 10.8% and 4.9% isolates of C. guilliermondii were resistant to fluconazole and voriconazole, respectively (7). Likewise, C. guilliermondii strains are found to be 2-fold to 16-fold less susceptible than other Candida species (excluding C. parapsilosis) to caspofungin, anidulafungin, and micafungin (7,28). In a multicenter study, Pfaller et al (9) examined 234 C. guilliermondii strains to determine epidemiologic cutoff values (ECVs) for anidulafungin and micafungin.…”

Fungemia in a university hospital: an epidemiological approach

“…It was established that the genus Candida is principally involved in the onset of nosocomial infections, where C. albicans fungemia is cited as the main cause, although there are increasing reports of blood infections caused by other species of Candida non-albicans and emergent fungi species 16,17 . Colombo 5 showed the detection of 145 candidemia in six hospitals in Brazil the prevalence of C. nonalbicans species in 63% of cases, C. parapsilosis and C. tropicalis, the predominant, although the last three decades in American teaching hospitals, C. albicans species has been responsible for more than sixfold increase in the frequency of fungemia by this yeast 18,19 .…”