Objectives: Non albicans Candida species have emerged as important nosocomial pathogens as the epidemiology of candidemia has changed over the years. Among 245 Candida bloodstream isolates, antifungal susceptibility data of 34 cases attributed to Candida parapsilosis is presented. Methods: A ten year surveillance of bloodstream infection (BSI) caused by C. parapsilosis was carried out in the Microbiology Laboratory of University Hospital of Patras. Gram stain of material from positive blood culture vials (Bact/Alert, Organon Teknika) was examined microscopically for yeasts, whereas, another portion was subcultured on Sabouraud dextrose agar (SDA, Difco, USA). All SDA plates were incubated at 35o C for 72h and yeast-like colonies were isolated. Germ tubes formation is indicative of C. albicans, whereas, germ tubes negative Candida isolates were identified by API 20 AUX (Biomerieux), an assimilation test of carbohydrates. Susceptibility testing (MIC) to antifungal agents was carried out by E-Test (AB Biodisk). MIC was evaluated according to CLSI criteria for amphotericin B (AP), 5-flucytocine (FC), fluconazole (FL), ketoconazole (KE), itraconazole (IT), voriconazole (VO), posaconazole (POS) and caspofungin (CS). Results: C. parapsilosis was the most frequent non-albicans candida species (14%), isolated from BSI. Fifteen candidemia cases (44%) due to C. parapsilosis were identified in Neonatal Intensive Care Unit (NICU), thirteen cases (38%) in Internal Medicine Ward, Haematology-Oncology Unit and Transplantation Center, five cases in Surgical Wards (General Surgery Units and Orthopedics), whereas, only one case was identified in adult ICU. Susceptibility data showed that all C. parapsilosis isolates were sensitive to AP, FC, VO, POS and CS. In terms of resistance to other azoles, four isolates were resistant to FL, two to KE and one to IT. Conclusions: Almost half (44%) of C. parapsilosis isolates were identified in NICU, where C. parapsilosis is the most common (25%) Candida non albicans causing BSI. In Surgical Wards and in adult ICU, the incidence of C. parapsilosis BSI is rather low. Parenteral alimentation and the widespread use of central venous catheters in low birth-weight infants have been linked to C. parapsilosis infections. Among azoles, the highest degree of resistance was observed to FL (12%) and KE (6%), whereas POS and VO were active against all isolates tested. No resistance was found to AP, FC and CS.
Full conference title:
19th European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 19th (2009)