Abstract
Changing trends in incidence and antifungal susceptibility patterns of six Candida species causing candidemia in Kuwait between 2006–2017 are reported. A total of 2075 isolates obtained from 1448 patients were analyzed. Identity of Candida species isolates was determined by phenotypic methods and confirmed by PCR amplification/PCR-sequencing of rDNA and/or MALDI-TOF MS. Antifungal susceptibility was determined by Etest. C. albicans accounted for 539 (37.22%) cases followed by C. parapsilosis (n = 502, 34.67%), C. tropicalis (n = 210, 14.5%), C. glabrata (n = 148, 10.22%), C. krusei (n = 27, 1.81%) and C. dubliniensis (n = 22, 1.5%). The comparative percent distribution of Candida species causing candidemia between 2006–2011 and 2012–2017 was as follows: C. albicans 41.8% and 33.1%, C. parapsilosis complex 32.01% and 37.04%, C. tropicalis 13.59% and 15.31%, and C. glabrata 8.77% and 11.51%, C. krusei 2.0% and 1.7%, and C. dubliniensis 1.75 and 1.3%, respectively. Three of 371 C. albicans isolates during 2006–2011 and five of 363 during 2012–2017 were resistant to fluconazole. Among C. parapsilosis isolates, one of 310 during 2006–2011 and 21 of 446 during 2012–2017 were resistant to this drug. Furthermore, at an epidemiologic cutoff value (ECV) of ≤0.5 μg/ml, 70.1% C. albicans isolates were wild-type for fluconazole during 2006–2011 as compared to 58.1% during 2012–2017. Likewise, at an ECV of ≤2 μg/ml, 98.0% of C. parapsilosis isolates were wild-type during 2006–2011 as compared to 93.4% during 2012–2017. Clonal spread of fluconazole-resistant C. parapsilosis in one major hospital was documented. An 8.8% shift in favor of non-albicans Candida species with concomitant increase in MICs between the two periods preludes emergence of fluconazole-resistant candidemia cases in Kuwait.
Highlights
Candida species are a major cause of healthcare-associated bloodstream infection (BSI) worldwide [1, 2]
While C. albicans continues to be the most frequently isolated bloodstream pathogen in most studies, there is a gradual shift towards non-albicans Candida species (C. glabrata, C. tropicalis, and C. parapsilosis), which together account for >50% cases of candidemia [1, 2, 4]
Considerable differences exist in the number of cases caused by individual non-albicans Candida species depending upon the geographic region, patient population, age and prior exposure to antifungal agents [1, 5]
Summary
Candida species are a major cause of healthcare-associated bloodstream infection (BSI) worldwide [1, 2] They are associated with considerable infection-related morbidity and mortality, in intensive care unit (ICU), where at least 50% episodes of candidemia occur [3]. While C. albicans continues to be the most frequently isolated bloodstream pathogen in most studies, there is a gradual shift towards non-albicans Candida species (C. glabrata, C. tropicalis, and C. parapsilosis), which together account for >50% cases of candidemia [1, 2, 4]. Considerable differences exist in the number of cases caused by individual non-albicans Candida species depending upon the geographic region, patient population, age and prior exposure to antifungal agents [1, 5]. Studies from Northern Europe and the USA [4, 6]
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