Abstract
Objectives: Invasive Candida infections pose a major public health problem worldwide and is a major cause of nosocomial bloodstream infection. Our aim was to assess dynamics in incidence, species distribution and antifungal susceptibility of candidemia episodes in Jerusalem, to better understand the epidemiology of invasive isolates and to better direct therapy.Methods: We analyzed the incidence dynamics, species distribution and susceptibility pattern of 899 candidemia episodes during 2005–2016 in Jerusalem.Results: The overall incidence of candidemia was relatively low of 0.62 per 1,000 admissions. Candida albicans was the leading pathogen (39.4%); however, there was a shift toward non-albicans species, with Candida glabrata predominating among them (40%). As expected, more than one-third of candidemias occurred in intensive care units. However, the distribution between species varied and Candida tropicalis was the leading pathogen in hematology-oncology patients. The susceptibility of isolates to antifungals remained stable throughout the years. Only a minority of Candida albicans isolates were non-susceptible to fluconazole (3.3%), however, an unexpectedly high resistance rate (37.8%) was observed in Candida parapsilosis isolates. We found an alarming rate of caspofungin resistance in Candida glabrata (33.6%) and Candida krusei (67%); this may reflect misclassification of resistance by the E-test method.Conclusions: This is the first comprehensive candidemia analysis in the Jerusalem area that should serve as a basis for decision-making regarding appropriate antifungal treatment in the hospital setting. The exceptional high resistance rate amongst Candida parapsilosis emphasizes the importance of antifungal susceptibility monitoring in medical centers serving large urban areas to better direct appropriate treatment.
Highlights
Candida species are a frequent cause of nosocomial bloodstream infection (BSI), with an incidence of 0.4–1.5/1,000 admissions and a high mortality rate of 15–49%, despite the availability of potent antifungal agents (Pfaller et al, 2010).In the recent years, a shift in the distribution of Candida species with increased incidence of non-albicans species surpassing Candida albicans was described (Pfaller et al, 2010)
In 2013, fluconazole non-susceptibility was uncommon among isolates of C. albicans and C. tropicalis globally, whereas a high rate of fluconazole non-susceptibility was noted among C. glabrata and C. parapsilosis (20.7 and 19%, respectively) (Castanheira et al, 2016)
We found a stable incidence of Candida albicans Candida glabrata Candida tropicalis Candida parapsilosis Candida krusei Overall
Summary
Candida species are a frequent cause of nosocomial bloodstream infection (BSI), with an incidence of 0.4–1.5/1,000 admissions and a high mortality rate of 15–49%, despite the availability of potent antifungal agents (Pfaller et al, 2010).In the recent years, a shift in the distribution of Candida species with increased incidence of non-albicans species surpassing Candida albicans was described (Pfaller et al, 2010). The Epidemiology of Candidemia antifungal susceptibilities, non-albicans Candida accounted for 52% of candidemia during 2013 with a predominance of Candida glabrata and Candida parapsilosis (Castanheira et al, 2016). In 2013, fluconazole non-susceptibility was uncommon among isolates of C. albicans and C. tropicalis globally, whereas a high rate of fluconazole non-susceptibility was noted among C. glabrata and C. parapsilosis (20.7 and 19%, respectively) (Castanheira et al, 2016). Resistance to echinocandin was low among all Candida species and ranged 0–2.8% (Castanheira et al, 2016) These antifungal susceptibility differences between Candida species may lead to different mortality rates. In a study examining fatal cases of candidemia, 61.5, 50, and 41.2% of C. glabrata, C. parapsilosis and C. albicans isolates, contributed to mortality, respectively (Cheng et al, 2005)
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