Candidemia in a French tertiary care hospital: frequency of different species and antifungal susceptibility

E. Mazars1, A. Panaque-Zulueta1, C. Cattoen1, F. Canis1, N. Séguy2

Author address: 

1Hospital, VALENCIENNES, France 2University of Burgundy, DIJON, France

Abstract: 

Objectives: Invasive Candida infections are associated with high mortality, especially in intensive care units. The changes in epidemiology and the emergence of antifungal resistance lead to permanent changes in medical practice. The knowledge of recent local epidemiologic trends and susceptibility to antifungals is critical in this context. Therefore, we reported preliminary epidemiologic characteristics of candidemia during 6 years. Methods: Our study is a retrospective, local, observational survey, from January 2003 to December 2008. All patients admitted in the tertiary hospital of Valenciennes, with candidemia, were included. It is a 1850-bed centre with an intensive care unit (19 beds), and haematologyoncology units. Clinical data is the current hospitalization. Mycological data are the identification and in vitro antifungal susceptibility of Candida isolates. The identification process was performed with a latex test, AuxacolorR test and chromogenic medium. The antifungal susceptibility testing were evaluated with E-testR for 5 antifungal molecules (amphotericin B, fluconazole, 5-flurocytosine, voriconazole and caspofungine). Results: During these 6 years, 117 candidemia were detected in our tertiary hospital. 3 patients (2,5%) developed a fungemia with 2 yeats : 2 with C. albicans and C. glabrata, 1 with C. albicans and Geotrichum capitatum. The numbers of candidemia and the C. albicans isolates are described for each year in the following table. insert table C. albicans was the most common pathogen (n= 67; 57%), followed by C. glabrata (n= 19; 16%), then C. parapsilosis (n= 14; 11%), C. tropicalis (n= 9; 7,5%), C. krusei (n= 5; 4% ), etc. The medico-surgical intensive care unit was the main hospitalization service (34 patients = 32%), followed by pneumology (19 patients = 16%), hematology (13 patients = 11%), surgery (10 patients = 9%). In vitro susceptibility to amphotericin B, fluconazole and 5-flurocytosine were determined for all 120 isolates, in vitro susceptibility to voriconazole and caspofungine respectively for 101 and 83 strains. The rate of fluconazole-resistant or sensible-dose dependent Candida was 23% (27 of 120 isolates), 3% (2 for 67) for C. albicans, 74% (14 for 19) for C. glabrata, 8% (1 for 13) for C. parapsilosis, and 50% (10 for 20) for all other species. Conclusion: From this preliminary study, the following points must be retained. The majority of candidemias is mainly detected out of the intensive care unit. The percentage of C. albicans in candidemia seems to increase since last few years. It is an a anusual data, compared with recent international trends. The susceptibility to fluconazole is under 80%, quiet low. This data justifies using caspofungine as the first antifungal therapy, which is a recent recommandation of IDSA guidelines.
2009

abstract No: 

P090

Full conference title: 

4th Trends in Medical Mycology
    • TIMM 4th (2012)