Background: Infections caused by non-albicans Candida sp. have increased dramatically. C. krusei is occasionally described in severely ill patients previously exposed to azole agents. Objective: Assess the incidence and clinical presentation of C. krusei fungemia, its susceptibility and its response to different antifungals. Methods: 420 episodes of fungemias were detected in our 1,750-bed institution in 1988-2000, and 11 caused by C. krusei (2.6%). Each C. krusei was compared to 3 C. albicans controls.Susceptibility was assessed with the modified microdilution method (M-27A, NCCLS), with RPMI-2% glucose medium. Panels were incubated at 35Â°C for 24-48 hours, and endpoints (50% growth reduction) were read visually. Results: 8 patients were male and mean age was 48 years (8 m - 67 y). All had debilitating conditions: HIV infection (3), hematologic malignancies (4), solid organ transplantation (2), lactose intolerance (1). Fungemia was community-acquired in 3 cases. When compared to C. albicans, patients, those with C. krusei had more commonly received antifungals (50% vs 20%, p=0.06), suffered hematological disease (40% vs 10%, p=0.03), or a transplant (20% vs 3%), were on corticosteroids (60% vs 16%) and were neutropenic (40% vs 0%). Cathtetrers were the most common origin for C. albicans and an unknown origin for C. krusei (70% vs 10%). C. krusei presented more commonly with skin lesions (30% vs 6%, p=0.005) or other septic metastasis (30% vs 6%%). Seven patients received AMB (2 deaths) and 2 FLU (cured). Overall mortality was 30% (43% for C. albicans). MIC90 results were: FLU 32 Âµg/ml, AMB 1Âµg/ml and VORI 0.12 Âµg/ml. HIV was a protective factor, while previos surgery and ICU admission were poor prognostic factors. Conclusion: C. krusei fungemia remains a rare finding despite widespread use of azole compounds in our media. HIV and hematologic malignancies are the main underlying conditions. Skin lesions are common. Voriconazole seems to be a very attractive alternative for the treatment of these infections.
Full conference title:
42nd Interscience Conference on Antimicrobial Agents and Chemotherapy
- ICAAC 42nd