Candida bloodstream infections: comparison of species distribution and resistance to echinocandin and azole antifungal agents in Intensive Care Unit (ICU) and non-ICU settings in the SENTRY Antimicrobial Surveillance Program (2008–2009)

• Published in: International journal of antimicrobial agents 2011-07, Vol.38 (1), p.65-69
• Main Authors: Pfaller, Michael A, Messer, Shawn A, Moet, Gary J, Jones, Ronald N, Castanheira, Mariana
• Format: Article
• Language: English
• Subjects: anidulafungin; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antifungal Agents - pharmacology; Azoles; Azoles - pharmacology; Bacterial diseases; Bacterial sepsis; biogeography; Biological and medical sciences; blood flow; Bloodstream infections; Candida; Candida - classification; Candida - drug effects; Candida - isolation & purification; Candida albicans; Candida glabrata; Candida krusei; Candida parapsilosis; Candida tropicalis; Candidaemia; Candidemia - epidemiology; Candidemia - microbiology; candidiasis; caspofungin; Drug Resistance, Fungal; Echinocandins; Echinocandins - pharmacology; fluconazole; Global Health; Hospitals; Human bacterial diseases; Human mycoses; Humans; Infectious Disease; Infectious diseases; Intensive Care Unit; Intensive Care Units; Medical sciences; micafungin; Microbial Sensitivity Tests - statistics & numerical data; minimum inhibitory concentration; monitoring; multiple drug resistance; Mycoses; Mycotic sepsis; patients; Pharmacology. Drug treatments; phenotype; Population Surveillance - methods; Species Specificity; surveys
• ISSN: 0924-8579; 1872-7913
• DOI: 10.1016/j.ijantimicag.2011.02.016

Minimum inhibitory concentration (MIC) data from the SENTRY Antimicrobial Surveillance Program generated by reference methods were analysed to compare the antifungal resistance profiles and species distribution of Candida bloodstream infection (BSI) isolates obtained from patients in the Intensive Care Unit (ICU) and those from non-ICU locations. Results from 79 medical centres between 2008 and 2009 were tabulated. MIC values were obtained for anidulafungin, caspofungin, micafungin, fluconazole, posaconazole and voriconazole. Recently revised Clinical and Laboratory Standards Institute breakpoints for resistance were employed. A total of 1752 isolates of Candida spp. were obtained from ICU (779; 44.5%) and non-ICU (973; 55.5%) settings. The frequency of ICU-associated Candida BSI was higher in Latin America (56.5%) compared with Europe (44.4%) and North America (39.6%). The frequency of candidaemia in the ICU decreased both in Latin America and North America over the 2-year study period. Approximately 96% of isolates both in ICU and non-ICU settings were caused by only five species (Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis and Candida krusei). Resistance both to azoles and echinocandins was uncommon in ICU and non-ICU settings. Overall, fluconazole resistance was detected in 5.0% of ICU isolates and 4.4% of non-ICU isolates. Candida glabrata was the only species in which resistance to azoles and echinocandins was noted, and this multidrug-resistant phenotype was found in both settings. In conclusion, the findings from this global survey indicate that invasive candidiasis can no longer be considered to be just an ICU-related infection, and efforts to design preventive and diagnostic strategies must be expanded to include other at-risk populations and hospital environments. Concern regarding C. glabrata must now include resistance to echinocandins as well as azole antifungal agents.