Epidemiology of Candidemia in a Spanish Tertiary Hospital: Identification and Molecular Mechanisms of Resistance

P. Merino, O. Zaragoza, M. Cuenca, J. Picazo

Author address: 

Clinico San Carlos Hosp., Madrid, Spain, Natl. Ctr. for Microbiol., Madrid, Spain.

Abstract: 

Background: Candidemia is a nosocomial infection with a high morbidity and mortality. Specific therapy must not be delayed as it affects prognosis. Guidelines recommend candins or lipid formulations of amphotericin B for initial treatment. Fluconazole in stable patients without azole-resistance risk factors. We studied the epidemiology of candidemia episodes in our hospital to identify species and susceptibility to nine antifungal, and mechanisms of resistance. Methods: We collected epidemiological and clinical data of 140 cases of candidemia. The identification of species was performed by sequencing the ribosomal DNA by oligonucleotides which amplify the ITS1-5.8-ITS2 region, further clustering (Infoquest software, Spanish Mycology Reference Lab database). Antifungal susceptibility testing was performed to Amphotericin B, Flucytosine, Fluconazole, Itraconazole, Voriconazole, Ravuconazole, Posaconazole, Caspofungin, Micafungin and Anidulafungin (EUCAST protocol). Amplification of the hot spots from the FSK1 gene was performed to Candida non-parapsilosis strains which MIC value for caspofungin was ≥ 0.5 μg/mL. Results: 24,1% patients were from oncohematology,24,03% ICU; 17,8%Surgery;14%InternalMedicine;10,9%Medical;6,2%Emergency; 3,1%neonatology (50,7% femail and 64,5 years average of age). 50% of the isolates were C.albicans, 25% C. parapsilosis, 10% C. glabrata and 5% C. tropicalis. The rest of the isolates were 1.5%. A total of 15% of isolates tested showed decreased susceptibility in vitro to fluconazole (MIC value >2 mg/L). 3% of C. albicans were resistant in vitro to this azole. The DNA sequence analysis of the HS1 and HS2 regions of the FKS1 gene revealed three strains of C. albicans presenting one polymorphism at the HS1, but none of them involved any change in the protein sequence. Conclusions: Half of the candidemias were caused by non albicans strains (25% C.parapsilopsis). We don’t find resistance to candinas in non parapsilosis strains. 15% of isolates had decresead susceptibility to fluconazol. Thus, we consider important to individualize the choice of antifungal depending on each case. We consider the importance of create surveillance programs with these patients
2013

abstract No: 

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Full conference title: 

53rd Interscience Conference on Antimicrobial Agents and Chemotherapy
    • ICAAC, 53rd (2013)