Background: Non-albicans Candida (NAC) CBSI and fluconazole (FLU)- resistance are on the rise, particularly in critically ill patients. This study assesses features of CBSI at UIC over time. Methods: After IRB approval, CBSI from 2001 to 2004 were identified from the microbiology lab, and clinical data and antifungal (AF) susceptibility testing (ST, routine since 2003) were recorded. AF purchase data were obtained from pharmacy. Complete response (CR) was defined as a negative blood culture (BC) after initiation of AFs and failure as persistence of CBSI despite therapy. Results: 247 pts had 276 episodes of CBSI. The percentage of C. albicans increased (43% in 2001 to 54% in 2004 [Fig 1]) and C. glabrata decreased (24% in 2001 to 16% in 2004). Simultaneously, caspofungin (CAS) and voriconazole use increased and use of amphotericin B (AB) products and itraconazole declined. FLU use was stable. CR occurred in 192/276 pts (70%) and another 2% had clinical Figure 1. Candida species by year. resolution without BC. Failure occurred in 5%, 9% died prior to AFs, 7% had repeat BC negative before AFs, 4% were lost to follow up, 3% died on AFs without repeat BC. CR rate by AF was: CAS 92%, lipid AB 90%, conventional AB 85%, FLU 79%. Failure rates by year (20012004) were 3%, 3%, 5%, and 10%. 4/13 failures where ST was available had decreased FLU susceptibility. Table 1. FLU Resistance. Conclusions: At UIC there has been an increase in C. albicans and decline in C. glabrata. However, C. glabrata displayed decreased FLU susceptibility over time and failure rates have increased.
Full conference title:
Infectious Diseases Society of America, 44th Annual Meeting
- IDSA 44th