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Epidemiology of candidaemia in non-neutropenic patients in an Italian tertiary-care hospital between 2005 and 2008

Abstract number: P1440

Azzini A.M., Recchia C., Tedesco A., Concia E.

Objective: To evaluate epidemiological trends in candidaemia (CA) between 2005 and 2008.

Methods: All cases of CA were identified retrospectively;demographic and clinical data were collected, together with data about the use of antifungal/antibacterial drugs, and others predisposing factors, within the 3 weeks before its onset. The antifungal susceptibility patterns were collected as well

Results: 100 episodes of CA were identified. The average incidence was 0.99/10000 patient-days/year, ranging from 1.2 in 2005 to 1.1 in 2007. 54% of CA occurred in ICUs, followed by surgical (30%) and medical (16%) wards. Most common predisposing factors were antibiotics (96%), CVC (94%), bladder catheter (93%), total parenteral nutrition (64%), mechanical ventilation (62%) and surgery (58%); steroids accounted for only 32% of cases, no-one was neutropenic or transplant recipient. C. albicans was isolated in 53% of cases, followed by C. parapsilosis (21%), C. glabrata (9%) and C. tropicalis (9%); non-albicans species never exceeded C. albicans (Table 1).

CVC related CA were 30% and in 9.6% of them CVC was not removed

87% of patients received antifungal therapy and in 92% of cases it was adequate; fluconazole was most frequently employed (74.7%), followed by caspofungin and any amphotericin B formulation (10.3% both), voriconazole (3.4%) and itraconazole (1.2%). No azole-resistant C. albicans was isolated, instead of 9.5% of C. parapsilosis that was fluconazole-resistant (n 2).

The 30-day crude mortality rate was 26%, 19.7% in adequately treated population.

Conclusions: The overall annual incidence of CA was high, but stable during the study period. Compared with a similar study conducted between 1992–2001, it showed an increased number of CA inside medical wards (16% vs 8%), and a significant reduction inside ICU (54% vs 65%). Interestingly inside surgical wards remained quite constant (30% vs 27%), in spite of the increasing number of surgical patients. CVC related CA decreased (30% vs 43%) instead of the widest use of CVC. If only 12% of patients with CA received an antifungal prophylaxis, the quite constant number of cases could be attributable to a sort of balance between the increasing patients' critical-status and the improved infection control policy, particularly inside ICU.

Although the consumption of fluconazole was high, C. albicans remained the predominant species (save for the first half of 2008), but we observed an increasing number of C. parapsilosis resistant to fluconazole

Candida spp.2005 (n = 37)2006 (n = 32)2007 (n = 22)2008 (n = 9)*Total
 MSUTIMSUTIMSUTIMSUTI 
C. albicans471126813820153%
C. parapsilosis02711321201121%
C. glabrata1010320001019%
C. tropicalis0020121210009%
C. guilliermondii0001010000002%
C. krusei0010000000102%
Others0010100010104%
Total5,9,23,4,12,16,4,6,12,3,3,3,100%
 13.5%24.3%62.2%12.5%37.5%50%18.2%27.3%54.5%33.3%33.3%33.3% 
C. albicans    22/37 (59.4%)    16/32 (50%)    12/22 (54.4%)    3/9 (33.3%) 
C. non albicans    15/37 (40.6%)    16/32 (50%)    10/22 (45.6%)    6/9 (66.7%) 
*First six months.

Session Details

Date: 16/05/2009
Time: 00:00-00:00
Session name: 19th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Helsinki, Finland, 16 - 19 May 2009
Presentation type:
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