TY - JOUR
T1 - Candidaemia associated with decreased in vitro fluconazole susceptibility
T2 - Is Candida speciation predictive of the susceptibility pattern?
AU - Oxman, David A.
AU - Chow, Jennifer K.
AU - Frendl, Gyorgy
AU - Hadley, Susan
AU - Hershkovitz, Shay
AU - Ireland, Peter
AU - McDermott, Laura A.
AU - Tsai, Katy
AU - Marty, Francisco M.
AU - Kontoyiannis, Dimitrios P.
AU - Golan, Yoav
N1 - Funding Information:
Y. G.’s contribution to this work was partially supported by a grant from Merck.
PY - 2010/4/29
Y1 - 2010/4/29
N2 - Background: Candidaemia is often treated with fluconazole in the absence of susceptibility testing. We examined factors associated with candidaemia caused by Candida isolates with reduced susceptibility to fluconazole. Methods: We identified consecutive episodes of candidaemia at two hospitals from 2001 to 2007. Species identification followed CLSI methodology and fluconazole susceptibility was determined by Etest or broth microdilution. Susceptibility to fluconazole was defined as: full susceptibility (MIC≤8 mg/L); and reduced susceptibility (MIC≥32 mg/L). Complete resistance was defined as an MIC.32 mg/L. Results: Of 243 episodes of candidaemia, 190 (78%) were fully susceptible to fluconazole and 45 (19%) had reduced susceptibility (of which 27 were fully resistant). Of Candida krusei and Candida glabrata isolates, 100% and 51%, respectively, had reduced susceptibility. Despite the small proportion of Candida albicans (8%), Candida tropicalis (4%) and Candida parapsilosis (4%) with reduced fluconazole susceptibility, these species composed 36% of the reduced-susceptibility group and 48% of the fully resistant group. In multivariate analysis, independent factors associated with reduced fluconazole susceptibility included male sex [odds ratio (OR) 3.2, P,0.01], chronic lung disease (OR 2.7, P=0.01), the presence of a central vascular catheter (OR 4.0, P,0.01) and prior exposure to antifungal agents (OR 2.2, P=0.04). Conclusions: A significant proportion of candidaemia with reduced fluconazole susceptibility may be caused by C. albicans, C. tropicalis and C. parapsilosis, species usually considered fully susceptible to fluconazole. Thus, identification of these species may not be predictive of fluconazole susceptibility. Other factors that are associated with reduced fluconazole susceptibility may help clinicians choose adequate empirical anti-Candida therapy.
AB - Background: Candidaemia is often treated with fluconazole in the absence of susceptibility testing. We examined factors associated with candidaemia caused by Candida isolates with reduced susceptibility to fluconazole. Methods: We identified consecutive episodes of candidaemia at two hospitals from 2001 to 2007. Species identification followed CLSI methodology and fluconazole susceptibility was determined by Etest or broth microdilution. Susceptibility to fluconazole was defined as: full susceptibility (MIC≤8 mg/L); and reduced susceptibility (MIC≥32 mg/L). Complete resistance was defined as an MIC.32 mg/L. Results: Of 243 episodes of candidaemia, 190 (78%) were fully susceptible to fluconazole and 45 (19%) had reduced susceptibility (of which 27 were fully resistant). Of Candida krusei and Candida glabrata isolates, 100% and 51%, respectively, had reduced susceptibility. Despite the small proportion of Candida albicans (8%), Candida tropicalis (4%) and Candida parapsilosis (4%) with reduced fluconazole susceptibility, these species composed 36% of the reduced-susceptibility group and 48% of the fully resistant group. In multivariate analysis, independent factors associated with reduced fluconazole susceptibility included male sex [odds ratio (OR) 3.2, P,0.01], chronic lung disease (OR 2.7, P=0.01), the presence of a central vascular catheter (OR 4.0, P,0.01) and prior exposure to antifungal agents (OR 2.2, P=0.04). Conclusions: A significant proportion of candidaemia with reduced fluconazole susceptibility may be caused by C. albicans, C. tropicalis and C. parapsilosis, species usually considered fully susceptible to fluconazole. Thus, identification of these species may not be predictive of fluconazole susceptibility. Other factors that are associated with reduced fluconazole susceptibility may help clinicians choose adequate empirical anti-Candida therapy.
KW - Antibiotic resistance
KW - Antifungals
KW - Candidiasis
KW - Fungal infections
UR - http://www.scopus.com/inward/record.url?scp=77954203947&partnerID=8YFLogxK
U2 - 10.1093/jac/dkq136
DO - 10.1093/jac/dkq136
M3 - Article
C2 - 20430790
AN - SCOPUS:77954203947
SN - 0305-7453
VL - 65
SP - 1460
EP - 1465
JO - Journal of Antimicrobial Chemotherapy
JF - Journal of Antimicrobial Chemotherapy
IS - 7
M1 - dkq136
ER -