The incidence of invasive fungal infections (IFI) world wide has increased significantly during the past 20 years affecting immunocompromised and ICU patients. Nosocomial fungemia rates in the United State increased almost fourfold. Several studies have documented trends in species distribution and antifungal susceptibility, both of which vary markedly by country and by time period. These studies show a mild increase in the proportion of candidemia due to non-C. albicans species, and the emergence of C. glabrata and C. parapsilosis as important agents of bloodstream infections during the past years. In addition, a trend of increased susceptibility of C. glabrata to fluconazole from 1997 to 1999 has also been reported. In this context, development of an organized surveillance program is essential to obtain reliable information on prevalence, antifungal resistance trends, and to detect others emerging pathogens. In view of this increasing importance of invasive fungal infections and the reports of the emergence of antifungal resistance in several countries, since March 2000 a prospective multicenter surveillance program for all fungi isolated from normally sterile sites was developed in Chile. This study describes general clinical data, species distribution and antifungal susceptibility profiles of yeasts isolated from IFI during the first year of surveillance. A total of 130 patients (56% male) with IFI were reported from 13 hospitals in Chile. Yeasts were isolated from 118 patients. The main patient groups affected were new born, children less than 1 year and adults between 50 to 79 years old. Bloodstream fungal infections were documented for 79 patients (61%) of whom 51% were male. The main risk factors recorded were antibiotic therapy (76%), central venous catheter (65%) and mechanic ventilation (42%). Nosocomial infections were represented in 63% of IFI and 83.5% of bloodstream infections. Candida albicans (40.8%), C. parapsilosis (13.1%), C. tropicalis (10%) and Cryptococcus neoformans (10%) were the most prevalent species recovered. A. fumigatus (3.1%) was the most frequent mold. From blood C. albicans (48.1%) and C. parapsilosis (17.7%) were the most frequent agents. S. cerevisiae and T. mucoides, two emergent pathogens were also isolated. All yeasts tested were susceptible to amphotericin B with CIM •1 µg/ml. Itraconazole and fluconazole resistance was observed in 4% and 6%, respectively. C. glabrata was the least susceptible species with 50% and 33% of resistance to both azoles, respectively, with one strain presenting co-resistance. This preliminary information of strains from IFI in Chile suggest that a continued surveillance on a national basis is necessary to monitor the dynamics of species variation and antifungal susceptibility patterns.
Full conference title:
The 15 th Congress of the International Society for Human and Animal Mycology
- ISHAM 15th (2003)