gms | German Medical Science

18th Symposium on Infections in the Immunocompromised Host

International Immunocompromised Host Society

15. to 17.06.2014, Berlin

Changes in the Epidemiology of Candida Associated Bloodstream Infections and Antifungal Resistance in Adult Patients from 2001 to 2009

Meeting Abstract

  • A. Cuartas-Abril - USA
  • P. Vermehern - USA
  • J. Cawley - USA
  • J. Mendez - Division of Infectious Disease, Jacksonville, FL, USA

18th Symposium on Infections in the Immunocompromised Host. Berlin, 15.-17.06.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14ichs18

doi: 10.3205/14ichs18, urn:nbn:de:0183-14ichs181

Veröffentlicht: 3. Juni 2014

© 2014 Cuartas-Abril et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Background: Candida infections are the fourth most common cause of nosocomial bloodstream infections and the third most common cause of these infections in the intensive care units. The epidemiology of fungal infections and levels of antifungal resistance have changed over the last 25 years and factors such as new chemotherapeutic and immunosuppressive agents, broad spectrum antimicrobials, bone marrow and organ transplantation, advanced surgical techniques and selection pressure induced by antifungal agents may all have significant implications in these changes.

Candida infections have emerged as one of the most important nosocomial infections worldwide associated with significant morbidity, mortality and cost to the health system.

Methods: We have conducted a retrospective review of all of the episodes of Candida associated blood stream infections at the Mayo Clinic Florida from 2001 to 2009. Clinical and microbiologic characteristics of these infections including species identification and resistance were reviewed and analyzed for the study period.

Results: We found 340 episodes of Candida associated blood stream infections for the study period. Candida glabrata (35%) was the most common species identified followed by Candida albicans (27%), Candida parapsilosis (19%) and Candida tropicalis (14.7%). The episodes of Candida associated blood stream infections per year increased from 2001 (28) to 2004 (58) followed by a gradual decrease of infections from 2005 (42) to 2009 (16). The episodes of Candida glabrata blood stream infections per year increased from 2001 (4) to 2005 (25) and gradually decreased from 2006 (17) to 2009 (6). The episodes of Candida albicans and parapsilosis blood stream infections per year remained relatively stable from 2001 to 2004 (5 to 16) and gradually decreased from 2005 to 2009 (1 to 5). The episodes of Candida tropicalis (3 to 9), krusei (1 to 2) and lusitaneae (1) blood stream infections per year remained stable from 2001 to 2009. Fluconazole resistance from 2001 to 2009 was found in 66.66% of Candida krusei, 23.33% of Candida glabrata, 12.76% of Candida tropicalis and 2.29 % of Candida albicans. Caspofungin resistance was not found in any of the Candida species analyzed for the study period.

The average time in the hospital for patients with Candida blood stream infections from 2001 to 2009 was 42.41 days and the 30 day mortality was 26.89%.

Conclusions: The epidemiology and antifungal resistance associated with Candida blood stream infections from 2001 to 2009 have changed in our hospital population. Candida glabrata was the most common species identified in these infections and the resistance to Fluconazole have increased to 23.33 %. Risk factors associated with these changes may include selection pressure induced by the antifungal agents and their increasing use for prophylaxis and therapy of infections. Other factors involved may include increasing levels of immunosuppression induced by newer chemotherapeutic and immunosuppressive regimens required for the management of patients undergoing therapy for cancer, bone marrow and solid organ transplantation along with the need for central venous catheters, total parenteral nutrition, extensive blood transfusions and advanced surgical techniques required by our complex patient population and some of these factors are currently under investigation.