Epidemiology, species distribution and in vitro antifungal susceptibility of fungaemia in a Spanish multicentre prospective survey
Por:
Peman, J, Canton, E, Quindos, G, Eraso, E, Alcoba, J, Guinea, J, Merino, P, Ruiz-Perez-de-Pipaon, MT, Perez-del-Molino, L, Linares-Sicilia, MJ, Marco, F, Garcia, J, Rosello, EM, Gomez-G-de-la-Pedrosa, E, Borrell, N, Porras, A, Yague, G, Sánchez-Reus F., FUNGEMYCA Study Grp
Publicada:
1 may 2012
Resumen:
To update the knowledge of the epidemiology of fungaemia episodes in Spain, the species implicated and their in vitro antifungal susceptibilities.
Episodes were identified prospectively over 13 months at 44 hospitals. Molecular methods were used to determine the cryptic species inside the Candida parapsilosis and Candida glabrata complexes. Susceptibility to amphotericin B, anidulafungin, caspofungin, fluconazole, flucytosine, itraconazole, micafungin, posaconazole and voriconazole was determined by a microdilution colorimetric method. New species-specific clinical breakpoints (SSCBPs) for echinocandins, fluconazole and voriconazole were applied.
The incidence of the 1357 fungaemia episodes evaluated was 0.92 per 1000 admissions. The incidence of Candida albicans fungaemia was the highest (0.41 episodes/1000 admissions), followed by Candida parapsilosis sensu stricto (0.22). Candida orthopsilosis was the fifth cause of fungaemia (0.02), outnumbered by Candida glabrata and Candida tropicalis. Interestingly, the incidence of fungaemia by C. parapsilosis was 11 and 74 times higher than that by C. orthopsilosis and Candida metapsilosis, respectively. Neither Candida nivariensis nor Candida bracarensis was isolated. Fungaemia was more common in non-intensive care unit settings (65.2) and among elderly patients (46.4), mixed fungaemia being incidental (1.5). Overall susceptibility rates were 77.6 for itraconazole, 91.9 for fluconazole and 96.599.8 for the other agents. Important resistance rates were only observed in C. glabrata for itraconazole (24.1) and posaconazole (14.5), and in Candida krusei for itraconazole (81.5).
Fungaemia is more common in non-critical patients. C. albicans is the most common species, followed by C. parapsilosis and C. glabrata. Nearly 90 of yeasts are susceptible to all antifungal agents tested. Resistance rates change moderately when applying the new SSCBPs.
Filiaciones:
Peman, J:
Hosp Univ La Fe, Microbiol Serv, Valencia 46009, Spain
Quindos, G:
Univ Basque Country, Fac Med, Dept Inmunol Microbiol & Parasitol, E-48080 Bilbao, Spain
Eraso, E:
Univ Basque Country, Fac Med, Dept Inmunol Microbiol & Parasitol, E-48080 Bilbao, Spain
Alcoba, J:
Hosp Nuestra Senora Candelaria, Tenerife, Spain
Guinea, J:
Hosp Gen Univ Gregorio Maranon, Madrid, Spain
Merino, P:
Hosp Clin San Carlos, Madrid, Spain
Ruiz-Perez-de-Pipaon, MT:
Hosp Virgen del Rocio, Seville, Spain
Perez-del-Molino, L:
Complejo Hosp, Santiago De Compostela, Spain
Linares-Sicilia, MJ:
Hosp Reina Sofia, Cordoba, Spain
Marco, F:
Hosp Clin Barcelona, Barcelona, Spain
Garcia, J:
Hosp La Paz, Madrid, Spain
Rosello, EM:
Hosp Valle De Hebron, Barcelona, Spain
Gomez-G-de-la-Pedrosa, E:
Hosp Ramon & Cajal, E-28034 Madrid, Spain
Borrell, N:
Hosp Son Dureta, Palma de Mallorca, Spain
Porras, A:
Hosp Carlos Haya, Malaga, Spain
Yague, G:
Hosp Univ Virgen de la Arrixaca, Murcia, Spain
Sánchez-Reus F.:
Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
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