AUTHOR=Rajendran Ranjith , Sherry Leighann , Deshpande Ashutosh , Johnson Elizabeth M. , Hanson Mary F. , Williams Craig , Munro Carol A. , Jones Brian L. , Ramage Gordon 

TITLE=A Prospective Surveillance Study of Candidaemia: Epidemiology, Risk Factors, Antifungal Treatment and Outcome in Hospitalized Patients

JOURNAL=Frontiers in Microbiology

VOLUME=7

YEAR=2016

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2016.00915

DOI=10.3389/fmicb.2016.00915

ISSN=1664-302X

ABSTRACT=<p>This study provide an up-to-date overview of the epidemiology and risk factors for <italic>Candida</italic> bloodstream infection in Scotland in 2012/2013, and the antifungal susceptibility of isolates from blood cultures from 11 National Health Service boards within Scotland. <italic>Candida</italic> isolates were identified by chromogenic agar and confirmed by MALDI–TOF methods. Survival and associated risk factors for patients stratified as <italic>albicans</italic> and non-<italic>albicans</italic> cases were assessed. Information on the spectrum of antifungals used was collected and summarized. The isolates sensitivity to different antifungals was tested by broth microdilution method and interpreted according to CLSI/EUCAST guidelines. Forty one percent of candidaemia cases were associated with <italic>Candida albicans</italic>, followed by <italic>C. glabrata</italic> (35%), <italic>C. parapsilosis</italic> (11.5%), and remainder with other <italic>Candida</italic> spp. <italic>C. albicans</italic> and C. <italic>glabrata</italic> infections were associated with 20.9 and 16.3% mortality, respectively. Survival of patients with <italic>C. albicans</italic> was significantly lower compared to non-<italic>C. albicans</italic> and catheter line removal in <italic>C. albicans</italic> patients significantly increases the survival days. Predisposing factors such as total parenteral nutrition, and number of days on mechanical ventilation or in intensive care, were significantly associated with <italic>C. albicans</italic> infections. Fluconazole was used extensively (64.5%) for treating candidaemia cases followed by echinocandins (33.8%). Based on CLSI breakpoints, MIC test found no resistance to any antifungals tested except 5.26% fluconazole resistance among <italic>C. glabrata</italic> isolates. Moreover, by comparing to EUCAST breakpoints we found 3.95% of <italic>C. glabrata</italic> isolates were resistant to anidulafungin. We have observed a shift in <italic>Candida</italic> spp. with an increasing isolation of <italic>C. glabrata</italic>. Delay and choice of antifungal treatment are associated with poor clinical outcomes.</p>