Fungaemia at a tertiary-care hospital: species distribution, antifungal susceptibility and antifungal therapy

K. Lagrou, J. Verhaegen, W.E. Peetermans, T. De Rijdt, J. Maertens, E. Van Wijngaerden

Author address: 

Leuven, BE

Abstract: 

Objectives: Few data are available regarding the susceptibility of Belgian yeast isolates to commonly used antifungal agents. Both species identification and antifungal susceptibility data are routinely used to guide antimicrobial therapy in episodes of candidemia. The aim of this study was to determine the susceptibility to seven antifungal agents for all yeasts isolated from blood cultures during a one year period and to review the species distribution and the antifungal therapy given. Methods: From June 2004 until June 2005, the first yeast isolate from each fungemic episode was collected and stored at -70 C. Susceptibility testing was performed using Sensititre YeastOne plate according to the instructions of the manufacturer. Antifungal drugs tested were fluconazole (FZ), amphotericin B (AB), voriconazole (VZ), caspofungin (CA), flucytosine (FC), ketoconazole (KZ) and itraconazole (IZ). Antifungal usage data for each patient with fungemia were obtained from the Hospital Pharmacy. Results: A total of 62 isolates from 60 patients were collected. 33% of the isolates were non-albicans species (11 Candida glabrata, 5 Candida parapsilosis, 1 Candida krusei, 1 Candida lusitaniae, 1 Candida tropicalis and 1 Saccharomyces cerevisiae). The susceptibility results (MIC range; MIC90s (mg/L)) for all isolates tested were as follows: FZ (16; 1). All C. albicans isolates were fully susceptible to FZ. 91% of the C. glabrata isolates showed decreased susceptibility (MIC >8 mg/L) to FZ, with one resistant isolate (MIC = 64 mg/L). VZ and CA inhibited 100% of the isolates at 8804;1 mg/L. VZ was less active against C. glabrata isolates with decreased susceptibility to FZ compared to FZ susceptible isolates. FZ was used in 75% of fungemic patients. CA was the second most commonly used antifungal therapy (11.7% of the patients). In four patients therapy was switched from FZ to CA, two to four days after isolation of the yeast from the blood culture. Conclusion: C. albicans was responsible for 67% of all fungemic episodes and remained fully susceptible to FZ. Decreased susceptibility to FZ was only observed for C. glabrata and C. krusei. CA was the compound with the highest in vitro activity.
2006

abstract No: 

P742

Full conference title: 

16th European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 16th (2006)