Activity of Triazoles and Echinocandins Against Candida Bloodstream Isolates at Phramongkutklao Hospital, Thailand

Abstract

Background: Candidemia is a major cause of morbidity and mortality which can be treated using antifungal agents, triazoles and echinocandins.
 Objectives: We aimed to determine Candida species and their sensitivities to triazoles (fluconazole, itraconazole, voriconazole, and posaconazole) and echinocandins (caspofungin, micafungin, and anidulafungin) among patients with candidiasis to guide future treatment of patients with candidemia or invasive candidiasis.
 Methods: All firstly isolated Candida spp. from patients admitted at Phramongkutklao Hospital, Bangkok, Thailand from January 2012 to December 2013 were included in this study. The antifungal susceptibility testing of Candida spp. isolates was assessed based on micro-dilution method.
 Results: During the 24-month study period, a total of 66 Candida isolates from 66 patients were identified. Of the 66 isolates, 35 (53%) were C. albicans, 18 (27.3%) were C. tropicalis, 10 (15.2%) were C. glabrata and 3 (4.5%) were C. parapsilosis. Fluconazole resistant Candida isolates were found in C. glabrata (100%), C. albicans (14.3%), C. tropicalis (22.2%) and C. parapsilosis (66.7%). Most Candida spp. isolates were mainly susceptible to echinocandins (>90%). Notably, 10%-20% of C. glabrata isolates showed resistance to echinocandins.
 Conclusion: Fluconazole, an empirical therapy, has been cautiously used due to resistant non-albicans Candida species especially, C. glabrata, C. tropicalis and C. parapsilosis. However, the emerging echinocandins resistant C. glabrata isolates need to be closely monitored.

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