A Prospective Surveillance Study of Candidaemia: Epidemiology, Risk Factors, Antifungal Treatment and Outcome in Hospitalized Patients.

Ranjith Rajendran,Carol A Munro,Elizabeth M Johnson,Gordon Ramage,Brian L Jones,Ashutosh Deshpande,Craig Williams,Leighann Sherry,Mary F Hanson

doi:10.3389/fmicb.2016.00915

Abstract

This study provide an up-to-date overview of the epidemiology and risk factors for Candida bloodstream infection in Scotland in 2012/2013, and the antifungal susceptibility of isolates from blood cultures from 11 National Health Service boards within Scotland. Candida isolates were identified by chromogenic agar and confirmed by MALDI–TOF methods. Survival and associated risk factors for patients stratified as albicans and non-albicans cases were assessed. Information on the spectrum of antifungals used was collected and summarized. The isolates sensitivity to different antifungals was tested by broth microdilution method and interpreted according to CLSI/EUCAST guidelines. Forty one percent of candidaemia cases were associated with Candida albicans, followed by C. glabrata (35%), C. parapsilosis (11.5%), and remainder with other Candida spp. C. albicans and C. glabrata infections were associated with 20.9 and 16.3% mortality, respectively. Survival of patients with C. albicans was significantly lower compared to non-C. albicans and catheter line removal in C. albicans patients significantly increases the survival days. Predisposing factors such as total parenteral nutrition, and number of days on mechanical ventilation or in intensive care, were significantly associated with C. albicans infections. Fluconazole was used extensively (64.5%) for treating candidaemia cases followed by echinocandins (33.8%). Based on CLSI breakpoints, MIC test found no resistance to any antifungals tested except 5.26% fluconazole resistance among C. glabrata isolates. Moreover, by comparing to EUCAST breakpoints we found 3.95% of C. glabrata isolates were resistant to anidulafungin. We have observed a shift in Candida spp. with an increasing isolation of C. glabrata. Delay and choice of antifungal treatment are associated with poor clinical outcomes.

Highlights

MATERIALS AND METHODSCandida species remain a significant cause of nosocomial bloodstream infections (BSIs), associated with prolonged hospital stay in the ICU and high healthcare cost (Rentz et al, 1998; Gudlaugsson et al, 2003)
We undertook a retrospective analysis of candidaemia patients in Scotland as means of understanding the national epidemiology of Candida species, associated risk factors and isolates sensitivity to Fluconazole Caspofungin Anidulafungin Micafungin Ambisome Voriconazole Other
Our previous Scottish candidaemia study (2005/06)(Odds et al, 2007) reported a prevalence of C. albicans and C. glabrata as 50 and 21%, respectively (Supplementary Table S1). This shows a changing trend in the prevalence of Candida spp in causing BSI, with a considerable decrease of C. albicans by 9% followed by a reciprocal increase of C. glabrata by 14%

Summary

Introduction

MATERIALS AND METHODSCandida species remain a significant cause of nosocomial bloodstream infections (BSIs), associated with prolonged hospital stay in the ICU and high healthcare cost (Rentz et al, 1998; Gudlaugsson et al, 2003). We undertook a retrospective analysis of candidaemia patients in Scotland as means of understanding the national epidemiology of Candida species, associated risk factors and isolates sensitivity to Fluconazole Caspofungin Anidulafungin Micafungin Ambisome Voriconazole Other Out of the 280 isolates collected in this study C. albicans predominated (41%), followed by C. glabrata (35%), C. parapsilosis (11.5%), C. tropicalis (3.6%), C. lusitaniae (3.6%), and other species (5.3%).

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