Ten-Year Study of Species Distribution and Antifungal Susceptibilities of Candida Bloodstream Isolates at a Brazilian Tertiary Hospital

Abstract

To describe the incidence and susceptibility profile of Candida bloodstream infections in a tertiary-care hospital, we performed a retrospective observational study from 1998 to 2007. Comorbidities and risk factors were compiled from all cases. In vitro susceptibility testing to fluconazole, itraconazole, voriconazole, and amphotericin B was performed for 100 isolates, and caspofungin was tested for C. parapsilosis complex. In a ten-year evaluation of candidemias, 44 % were caused by C. albicans, and species of the C. parapsilosis complex were the second most frequent agents (37 %). Other species presented lower incidences (C. tropicalis, 13 %, C. glabrata, 5 %, and C. krusei, 1 %). Neither C. dubliniensis nor C. metapsilosis were observed in this study. C. orthopsilosis (3 %) and C. parapsilosis stricto sensu (34 %) were also found. Species distribution was independent of catheterization, mechanical ventilation, or previous use of antifungals or corticoids. Parenteral nutrition administration was strongly related to C. glabrata infection, and the highest mortality (80 %) was observed in patients infected by this species. All C. albicans isolates showed high susceptibility to all tested drugs. However, two C. parapsilosis stricto sensu isolates presented high minimum inhibitory concentration (MIC) (4 mg/L each) to fluconazole, and one exhibited voriconazole MIC of 0.25 mg/L, highlighting the cross-resistance to these azoles. All isolates of C. tropicalis and C. glabrata showed no resistance to any drug tested. No difference was noted between C. parapsilosis and C. orthopsilosis susceptibilities to caspofungin. Our results suggest that resistance to amphotericin B, fluconazole, voriconazole, itraconazole, and caspofungin in Brazilian Candida bloodstream isolates is still uncommon.

Candida profiles and antifungal resistance evolution over a decade in Lebanon

“…This is in accord with most studies from our region [12][13][14][15][16][17][18][19][20][21][22][23][24] and from different parts of the world [31,34,35], where all Candida isolates exhibited high susceptibility to amphotericin B, with MICs of up to 1 mg/L. In contrast, the majority of the isolates in our study showed high levels of resistance (35%-79%) to itraconazole.…”

“…Though C. dubliniensis is known to be a causative agent of oral mucocutaneous infection, and has been described as a candidemia agent since 1999, our findings are in concordance with the reported low frequency (0.35%-3%) from different parts of the world [33,34].…”

“…In contrast, the majority of the isolates in our study showed high levels of resistance (35%-79%) to itraconazole. This is different from what was reported in a Brazilian study, where all the isolates exhibited high susceptibility to this drug [34]. However, in the USA [31], high resistance was reported among C. tropicalis (22%), C. glabrata (59%), and C. krusei (23%).…”

“…However, published studies have reported that both C. albicans and non-albicans distribution was more frequently recovered from ICU patients than from those on the wards, mostly ascribed to the use of central venous catheterization; comorbidity conditions such as diabetes mellitus were additional contributors to infection [19,33,34].…”

“…is not necessarily paralleled or associated with the higher recovered species. For example, Bonfietti et al [34] reported that C. glabrata ranked the lowest in recovery but its mortality in patients was the highest (80%) compared to C. tropicalis (77%), C. albicans (55%), and C. parapsilosis (47%).…”