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Epidemiology of candidaemia and antifungal susceptibility patterns in a Turkish university hospital

Abstract number: 1734_185

Serin Senger S., Demirbilek M., Kurt Azap O., Timurkaynak F., Arslan H.

Objective:Candida species are the fourth most common cause of hospital-acquired bloodstream infection. Our objective was to evaluate the Candida species and antifungal drug resistance.

Methods: The study was conducted retrospectively from Feb. 2005 to Oct. 2006. Antifungal susceptibility test was performed according to CLSI M27-A protocol and MIC values were also determined by using E-test and RPMI 1640 agar with 2% glucose.

Results: A total of 32 candidaemia episodes were encountered in 31 patients. Overall, 25 (78.1%) episodes were due to C. albicans, followed by 2 (6.3%) of C. tropicalis, 2 of C. famata, and 1 (3.1%) of C. parapsilosis, C. glabrata, and C. guillermondii each. The invitro activities of all tested agents are outlined in the table. Only one C. albicans strain (4%) was susceptible dose-dependently (SDD) to fluconazole, all others were susceptible. The same strain was also SDD to itraconazole, but the voriconazole MIC value was <1 mg/L. MIC values of non-albicans strains were higher than C. albicans strains. Resistance to fluconazole was detected in the C. parapsilosis strain and this strain was SDD to itraconazole. C. guillermondii strain was resistant to caspofungin (MIC > 32 mg/L). None of the other strains of Candida spp. had MIC value greater than 1 mg/L to caspofungin, amphotericin B and voriconazole. Twenty four (77.4%) of the patients were in ICU, 6 (19.4%) of whom had burns. CVC were in place in 29 (93.5%) patients. Prior antibiotic usage was present in 30 (96.8%) patients. Fifteen (48.4%) patients were subject to total parenteral nutrition. As an underlying condition, 8 (25.8%) had prior abdominal surgery, 10 (32.3%) had malignancy, and 10 (32.3%) had chronic renal failure. Prior fluconazole usage within a month of the first positive blood culture for Candida spp. was present for 22 (71%) patients, two of whom had fluconazole-resistant or -SDD candidaemia. 11 episodes were treated with fluconazole and 18 with caspofungin. The overall mortality rate was 45.2%.

In vitro susceptibilities of bloodstream Candida spp. isolates.

Antifungal agentMIC (mg/L)
MIC50MIC90aRange  
C. albicans (n = 25)
Fluconazole0.2510.06–16
Itraconazole0.020.090.008–0.25
Voriconazole0.0120.0640.002–0.64
Caspofungin0.030.060.012–0.25
Amphotericin B0.0470.120.002–0.125
Non-albicans Candida spp. (n = 7)
Fluconazole0.75ND0.12–>256
Itraconazole0.03ND0.016–0.5
Voriconazole0.016ND0.003–0.19
Caspofungin0.03ND0.002–>32
Amphotericin B0.094ND0.003–0.5
Total (n = 32)
Fluconazole0.2510.06–>256
Itraconazole0.020.090.008–0.5
Voriconazole0.0160.0640.002–0.64
Caspofungin0.030.060.002–>32
Amphotericin B0.0470.120.002–0.5
aND, not determined.

Conclusion:C. albicans was found as the most common cause of candidaemia. Our study suggests that fluconazole resistance has not emerged among bloodstream isolates of C. albicans, although isolated from patients at high risk. Although number of non-albicansCandida strains is too low, fluconazole resistance was detected in one strain (14.3%). Present study shows that even for the patients at high risk, fluconazole still remains the drug of choice for C. albicans strains.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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