Abstract
This analysis describes the epidemiology and outcomes of invasive candidiasis caused by non-albicans species of Candida in patients enrolled in the Prospective Antifungal Therapy Alliance (PATH Alliance) registry from 2004 to 2008. A total of 2,496 patients with non-albicans species of Candida isolates were identified. The identified species were C. glabrata (46.4%), C. parapsilosis (24.7%), C. tropicalis (13.9%), C. krusei (5.5%), C. lusitaniae (1.6%), C. dubliniensis (1.5%) and C. guilliermondii (0.4%); 111 infections involved two or more species of Candida (4.4%). Non-albicans species accounted for more than 50% of all cases of invasive candidiasis in 15 of the 24 sites (62.5%) that contributed more than one case to the survey. Among solid organ transplant recipients, patients with non-transplant surgery, and patients with solid tumors, the most prevalent non-albicans species was C. glabrata at 63.7%, 48.0%, and 53.8%, respectively. In 1,883 patients receiving antifungal therapy on day 3, fluconazole (30.5%) and echinocandins (47.5%) were the most frequently administered monotherapies. Among the 15 reported species, 90-day survival was highest for patients infected with either C. parapsilosis (70.7%) or C. lusitaniae (74.5%) and lowest for patients infected with an unknown species (46.7%) or two or more species (53.2%). In conclusion, this study expands the current knowledge of the epidemiology and outcomes of invasive candidiasis caused by non-albicans species of Candida in North America. The variability in species distribution in these centers underscores the importance of local epidemiology in guiding the selection of antifungal therapy.
Highlights
Candidemia and other forms of invasive candidiasis (IC; defined as candidemia or infection involving normally sterile sites) are unquestionably the most prevalent of the invasive mycoses worldwide [1,2]
Among the 6,845 patients with completed case reports of IFIs, 5,036 (73.6%) patients with candidemia or other forms of IC were identified by the Prospective Antifungal Therapy (PATH) Alliance registry, 2,496 (49.6%) of which were cases of IC due to non-albicans Candida (N-CA) species
The rank order of the seven most frequently encountered N-CA species was C. glabrata.C. parapsilosis.C. tropicalis.C. krusei.C. lusitaniae.C. dubliniensis.C. guilliermondii in 13 of the 24 sites (54.2%) that contributed more than one case to the survey
Summary
Candidemia and other forms of invasive candidiasis (IC; defined as candidemia or infection involving normally sterile sites) are unquestionably the most prevalent of the invasive mycoses worldwide [1,2]. Longitudinal surveillance studies from individual institutions, cities, countries, and broad geographic regions have documented the emergence of the various non-albicans Candida (N-CA) species as well as their potential to develop antifungal resistance [3,6,12,13,14,15,16,17,18,19,20,21]. Resistance to fluconazole and echinocandins has been shown to be more common in N-CA species compared with C. albicans isolates in a population based laboratory study [13], and is in part due to N-CA species that are inherently resistant to antifungals, such as C. krusei to fluconazole [13] and the greater propensity of species such as C. glabrata to develop antifungal resistance [22]. Local epidemiological data continue to be of major importance in guiding empirical antifungal therapy in patients with a high probability of developing candidemia [7,28,29,30]
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