Species distribution and in vitro antifungal susceptibility profiles of yeast isolates from invasive infections during a Portuguese multicenter survey
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This is the first Portuguese multicenter observational and descriptive study that provides insights on the species distribution and susceptibility profiles of yeast isolates from fungemia episodes. Ten district hospitals across Portugal contributed by collecting yeast isolates from blood cultures and answering questionnaires concerning patients’ data during a 12-month period. Molecular identification of cryptic species of Candida parapsilosis and C. glabrata complex was performed. The susceptibility profile of each isolate, considering eight of the most often used antifungals, was determined. Both Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) protocols were applied. The incidence of 240 episodes of fungemia was 0.88/1,000 admissions. Fifteen different species were found, with C. albicans (40 %) being the most prevalent, followed by C. parapsilosis (23 %) and C. glabrata (13 %). Most isolates were recovered from patients admitted to surgical wards or intensive care units, with 57 % being males and 32 % aged between 41 and 60 years. For both the CLSI and EUCAST protocols, the overall susceptibility rates ranged from 74 to 97 % for echinocandins and from 84 to 98 % for azoles. Important resistance rate discrepancies between protocols were observed in C. albicans and C. glabrata for echinocandins and in C. parapsilosis and C. tropicalis for azoles. Death associated with fungemia occurred in 25 % of the cases, with more than half of C. glabrata infections being fatal. The great number of Candida non-albicans is noteworthy despite a relatively low antifungal resistance rate. Studies like this are essential in order to improve empirical treatment guidelines.
KeywordsMicafungin Sensu Stricto Candida Glabrata Yeast Isolate Candida Parapsilosis
We would like to thank all the participants whom have contributed with isolates and clinical data: J. Melo Cristino (Centro Hospitalar de Lisboa Norte); V. Lopes, J. Teixeira, and H. Ramos (Centro Hospitalar do Porto); C. Toscano and T. Marques (Centro Hospitalar de Lisboa Ocidental); Z. Videira, A. Almeida, E. Tiza, and M. Silveira (Instituto Português de Oncologia de Lisboa); G. Gonçalves and A. Estrada (Hospital de São Marcos, Braga); A. C. Lameiras and M. A. Guimarães (Instituto Português de Oncologia do Porto); H. Oliveira and M. H. Pereira (Centro Hospitalar de Coimbra); E. Ramalheira and S. Ferreira (Hospital Infante Dom Pedro, Aveiro). We would also like to acknowledge the collaboration of “Grupo de Estudos de Micologia Médica” (GEMM).
This work was supported by Fundação Ciência e Tecnologia (FCT, project PTDC/DTP-EPI/1660/2012 “Surveillance of the emergent Candida parapsilosis antifungal resistance”.
I. Faria-Ramos is supported by an FCT PhD grant (SFRH/BD/91155/2012).
This work was financially supported by Pfizer Inc. grant WS759839.
Conflict of interest
No conflicts to declare.
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