Epidemiology, species distribution and antifungal susceptibility activity of Candida bloodstream infections in a university hospital

Lemonia Skoura, Antonia Lanta, Zoi Tegou, Efthymia Protonotariou, Olga Vasilaki, Eirini Christaki, Georgia Kagkalou, Melina Kachrimanidou, Olga Tsachouridou, Simeon Metallidis, Prof. Nikolaos Malisiovas


Background: Candidemia is an important cause of bloodstream infection and often is associated with high mortality and morbidity in health care settings. The aim of this study was to evaluate the epidemiology, risk factors, species identification and in vitro antifungal susceptibility associated with Candida infections.

Material/methods: We conducted a retrospective analysis of demographic data, species identification and patient medical history associated with candidemia at AHEPA University Hospital from January 2012 to August 2015. An episode of candidemia was defined as at least one positive blood culture during a single hospitalization. Candida species were isolated from blood using the automated system BacT/ALERT 3D (biomerieux, France). The species identification and antifungal susceptibility testing to fluconazole, amphotericin B, flucytocin, voriconazole and were performed using the automated system Vitek 2 (biomerieux, France).

Results: A total of 75 episodes of candidemia were identified during the study period. Age range of patients varied from 27 to 88 years and 57.1 % of them were males. From the above patients, 77 Candida species were isolated. Candida albicans was the leading cause of infection (39/77, 50.6%) followed by C. parapsilosis (25/77, 32.5%), C. glabrata (6/77, 7.8%), C. tropocalis (4/77, 5.2%), C. famata (2/77, 2.6%) and C. lusitaniae (1/77, 1.3%). Many of the patients had one or more comorbidities at the time of candidemia diagnosis; 16% of them suffered from chronic kidney failure and were under haemodialysis, 12% had cancer and 8% suffered from chronic blood disease. Most common reason for hospitalization was pneumonia (12%) followed by head trauma and brain hemorrhage (11%). At the time of the candidemia diagnosis, all of the patients were receiving broad-spectrum antibiotics. In vitro antifungal activity showed that C. parapsilosis, C. tropicalis and C lusitanie strains were found susceptible to all antifungals tested. For C. abicans strains, 4 strains (out of 11) were found with reduced susceptibility to flucanozole, amphotericin B and fluocytocine. As for C. glabrata, 2 strains were found resistant to fluconazole and susceptible to the other antifungal drugs.

Conclusions:  Candida albicans was the most common cause of fungal infection in our institution.  Candida parapsilosis was the most common cause of fungal infection among the non albicans species.  The major predisposing factor in patients with candidema were prior broad-spectrum antibiotic use.  All Candida isolates -except few cases of C. albicans and C. glabrata - showed very good in vitro susceptibility activity to all tested antifungals.


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26th European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 26th (2016)