Population-Based Surveillance for Candida Bloodstream Infections in Barcelona: Epidemiology and Incidence of Fluconazole Resistance.

B. ALMIRANTE, D. RODRIGUEZ, J. MORGAN, B. PARKER, M. ALMELA, A.M. PLANES, J. AYATS, M. GIMENEZ, F. SANCHEZ, M. CUENCA-ESTRELLA, D. WARNOCK, J.L. RODRIGUEZ-TUDELA, A. PAHISSA

Author address: 

Barcelona Candidemia Project, Barcelona, Spain.

Abstract: 

Background: Candida bloodstream infections (BSI) are the fourth leading cause of healthcare-related BSI in the US, with an estimated incidence of 10/100,000 population. There are no reports to date on population-based rates of Candida BSI or the incidence of fluconazole resistance in Spain. Methods: Population-based surveillance began in Jan 2002 for Candida BSI in 14 hospitals in Barcelona, Spain (population 4,805,927). An incident case was defined as the first isolation of Candida spp from the blood of a Barcelona resident. We prospectively collected demographic, clinical, and outcome data on each case, and performed antifungal susceptibility testing on each isolate using NCCLS M27A guidelines. Results: 167 cases were identified during 2002, resulting in an incidence of 3.5/100,000 population. Median age of cases was 64 years (range 0-90 years), with 12% less than 1 year; 10% were outpatients, 40% had an underlying malignancy, 13% were neutropenic, 11% were transplant recipients, 4% infected with HIV, 73% had a central venous catheter and 40% underwent surgery in the 3 months prior to candidemia. Overall mortality was 44%. C.albicans isolates comprised 57%, followed by C. parapsilosis (19%), C.glabrata (8%), C.tropicalis (7%), C. krusei (4%) and other species (5%). No isolates were resistant to amphotericin B (MIC>1mg/ml). Five were fluconazole resistant with MIC 364 mg/ml (1 C.parapsilopsis, 1 C. tropicalis, 1 C. glabrata and 2 C. krusei) and 10 isolates (5 C.glabrata, 4 C. krusei and 1 C. inconspicua) were susceptible dose-dependent (MIC:16-32 mg/ml). Conclusions: This is the first population-based Candida BSI study conducted in Europe. While the incidence of Candida BSI in Barcelona is lower than in the US, risk factors, the population at risk, and the low level of fluconazole resistance appear to be similar.
2003

abstract No: 

M-1003

Full conference title: 

43rd Interscience Conference on Antimicrobial Agents
    • ICAAC 43rd