Adult and neonatal intensive care unit candidaemia: retrospective analysis
Abstract number: P853
Objectives: To investigate the isolation and distribution rate of Candida spp. in blood cultures and to evaluate antifungal susceptibility during a 12-year period (19972009) in a tertiary care hospital's adult (AICU) and neonatal (NICU) intensive care units.
Methods: Positive blood cultures (BacT/Alert, Organon Teknika) were examined microscopically directly for yeasts or pseudohyphae and subcultured on Sabouraud dextrose agar (Difco). Candida isolates were screened by germ tubes test and identified using API 20CAUX and automated VITEK system (both Biomerieux). Antifungal susceptibility was carried out by E-test (AB Biodisk) on RPMI -2% glucose agar. MIC was evaluated according to CLSI criteria for the following antifungal agents: amphotericin B (AM), 5-fluorocytocin (FC), ketoconazole (KE), itraconazole (IT), fluconazole (FL), voriconazole (VO), posaconazole (PO) and caspofungin (CF). According to European Organization for Research and Treatment of Cancer, an episode of candidaemia was defined as one or more positive blood cultures for Candida species isolated from patients with clinical signs of infection. Subsequent positive cultures were defined as new episode, only if there was an interval of at least 12 weeks between the two episodes.
Results: During the study period there were 285 candidemia cases. Thirty three (33) cases were identified in AICU and sixty five (65) cases in NICU The causative species in AICU / NICU were: C. albicans 22 strains (67%) / 39 strains (60%), C. parapsilosis 6 (18%)/18(27.7%), C. glabrata 3 (9%)/5 (7.7%), C. tropicalis 2 (6%)/2 (3.1%) and C. guilliermondii 0 (0%)/1 (1.5%). In terms of susceptibility to antifungals, C. albicans isolates demonstrated excellent sensitivity rates to AM, FC and CF, whereas the highest resistance rates were observed to azoles, especially IT (27% and 16% in AICU and NICU respectively), FL (18% and 8%) and KE (14% and 16%). C. parapsilosis isolates were sensitive to all antifungals with the exception of IT (11% resistance in NICU). C. glabrata and C. tropicalis demonstrated the higher resistance rates to azoles among all Candida.
Conclusions: ICU Candidemia is predominantly caused by C. albicans. Parenteral alimentation and use of central venous catheters seem to be associated with high incidence of C. parapsilosis, which is the second predominant specie in both ICUs. C. glabrata is the third more often isolate and its identification is clinically important due to high resistance to azoles.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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