Change in species distribution and antifungal susceptibility of candidemias in an intensive care unit of a university hospital (10-year experience)

Abstract

Candidemia is a nosocomial infection mostly found in critically ill patients. Our objectives were to evaluate the change in distribution and resistance profile ofCandidaspp. 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; 238Candidaspp. 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% forC. albicans(n = 76),C. parapsilosis(n = 67),C. glabrata(n = 40), andC. tropicalis(n = 27), respectively. Resistance rate to anidulafungin was high inC. parapsilosisover both periods and increased to 73% in the second period. Fluconazole showed a remarkable decrease for susceptibility inC. parapsilosis(94 to 49%). The prevalence of MDRC. parapsilosis(6%/33%) andC. glabrata(0%/44%) increased in the second period. We observed a predominance of non-albicansCandidaspp., withC. parapsilosisbeing the most frequent andC. glabratainfections presenting with the highest mortality. High level of echinocandin resistance inC. parapsilosisand increasing prevalences of MDRC. parapsilosisandC. glabrataseem emerging challenges in our institution.