Change in species distribution and antifungal susceptibility of candidemias in an intensive care unit of a university ho
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ORIGINAL ARTICLE
Change in species distribution and antifungal susceptibility of candidemias in an intensive care unit of a university hospital (10-year experience) Bilgul Mete 1 & Esra Yerlikaya Zerdali 2 & Gokhan Aygun 3 & Nese Saltoglu 1 & Ilker Inanc Balkan 1 & Ridvan Karaali 1 & Sibel Yildiz Kaya 4 & Berna Karaismailoglu 1 & Abdurrahman Kaya 5 & Seval Urkmez 6 & Gunay Can 7 & Fehmi Tabak 1 & Recep Ozturk 8 Received: 28 May 2020 / Accepted: 20 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Candidemia is a nosocomial infection mostly found in critically ill patients. Our objectives were to evaluate the change in distribution and resistance profile of Candida spp. isolated from candidemic patients in our intensive care unit over two 5-year periods spanning 15 years and to evaluate the risk factors. Records from the microbiology laboratory were obtained, from January 2004 to December 2008 and from January 2013 to December 2017, retrospectively. Antifungal susceptibility was performed by E-test and evaluated according to EUCAST breakpoints. A total of 210 candidemia cases occurred; 238 Candida spp. were isolated in 197 patients (58.8% male; mean age, 59.2 ± 19.6 years). The most predominant risk factor was central venous catheter use. Species distribution rates were 32%, 28%, 17%, and 11% for C. albicans (n = 76), C. parapsilosis (n = 67), C. glabrata (n = 40), and C. tropicalis (n = 27), respectively. Resistance rate to anidulafungin was high in C. parapsilosis over both periods and increased to 73% in the second period. Fluconazole showed a remarkable decrease for susceptibility in C. parapsilosis (94 to 49%). The prevalence of MDR C. parapsilosis (6%/33%) and C. glabrata (0%/44%) increased in the second period. We observed a predominance of non-albicans Candida spp., with C. parapsilosis being the most frequent and C. glabrata infections presenting with the highest mortality. High level of echinocandin resistance in C. parapsilosis and increasing prevalences of MDR C. parapsilosis and C. glabrata seem emerging challenges in our institution. Keywords Candida . Species . Candidemia . Susceptibility . E-test
Introduction Candidemia is one of the three most frequently encountered nosocomial bloodstream infections [1, 2]. The incidence of candidemia was reported as 1.2 and 25 cases per 100,000
* Bilgul Mete [email protected] 1
Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
persons, 1.22 episodes per 1000 discharges in studies from Europe, United States, and Asia, respectively. [3–5]. Candidemia is a nosocomial infection found mostly in critically ill, immunosuppressed, and surgical patients; it leads to prolonged hospitalization and presents with high morbidity
4
Department of Infectious Diseases and Clinical Microbiology, Sungurlu State Hospital, Corum, Turkey
5
Department of Infectious Diseases and Clinical Microbiology, Istanbul Research and Training Hospital, Istanbul, Turkey
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