Emerging trends in Candidemia by C. glabrata: A better outcome in a worse setting

Ref ID: 18797

Author:

G. Fresco, MD (Doctor of Medicine) – ID Physician, P. Martí­n-Dávila, MD – ID Physician, J. Fortún, MD – ID Physician, E. Gómez-Garcí­a de la Pedrosa, MD – Microbiologist, V. Pintado, MD – ID Physician, J. Cobo, MD – ID Physician, Y. Meije, MD – ID Phy

Author address:

Hosp. Ramon Y Cajal, Madrid, Spain.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: A significant increase in the incidence of candidemia by C. glabrata has been observed in recent years associated with an increase in comorbidity factors. Methods: All episodes of candidemia by C. glabrata during two 6-years periods (2000-2005 and 2006-2011) were analyzed in a tertiary-care hospital. Results: During the study period, 64 patients (pts) had candidemia due to C. glabrata (14.6% of total candidemic episodes). A 79.6% occurred in the last five years, 86% were nosocomial, 43.8% happened in ICU pts, 50% had undergone a recently major surgery, 54.7% occurred in cancer pts, 26.6% were immunosuppressed pts and 6.3% had neutropenia (<500/mm3). Primary candidemia were 46.7%, and 28% were catheter-related BSI. A 22% had previously received an azole (mean days: 11.8). Although fluconazole was the most used empirical therapy (81%), the final antifungal treatment was an echinocandin (50%), followed by azoles (45%) and amphotericin-B (5%). Breakthrough candidemia was 26.6%. Mortality was 32.8%, and was significant higher in pts treated with fluconazol (37%) vs echinocandin (24%)(p<0.05). All breakthrough candidemic episodes take place in the second period, and surgical and oncology patients have increased twice. Early mortality was lower in this period (27.5%vs 53.8%,p=0.06), and the use of echinocandins has increased ( 15.4% vs 43.1%,p=0.05). Conclusions: Candidemia due to C. glabrata are becoming more frequent, especially in ICU, cancer and complex surgical patients. Inadequate treatment with azoles is associated with a higher mortality. In contrast to the increase in comorbid conditions observed in recent years, mortality has decreased in parallel with an increase in echinocandins use.

Abstract Number: M-323

Conference Poster: y

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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