Species distribution and antifungal susceptibility of Candida bloodstream isolates in Kuwait: a 10-year study

Abstract

Bloodstream infections due to Candida species are important complications in severely ill hospitalized patients. This study presents data on species distribution and antifungal susceptibility profiles of Candida bloodstream isolates obtained from Kuwait during a 10-year period. All the bloodstream isolates were identified to species level by the germ tube test and carbohydrate assimilation profile using the VITEK 2 yeast identification system. Using E-test strips for amphotericin B, fluconazole, 5-flucytosine and voriconazole, MICs were determined on RPMI agar supplemented with 2 % glucose. The MIC breakpoints for resistance were based on Clinical and Laboratory Standards Institute criteria or those published by reference laboratories, and were as follows: amphotericin B, >1 mg ml . In all, 607 bloodstream yeast isolates were obtained over the past 10 years in Kuwait. Candida albicans was the predominant species (39.5 %), followed by Candida parapsilosis (30.6 %), Candida tropicalis (12.4 %), Candida glabrata (5.6 %) and Candida krusei (1.6 %). All C. albicans, C. tropicalis and C. glabrata isolates were susceptible to amphotericin B. Of 186 isolates of C. parapsilosis tested, only four (2 %) exhibited an MIC for amphotericin B of >1 mg ml "1 . Resistance to fluconazole was observed in nine (3.8 %) C. albicans isolates, two (5.8 %) C. glabrata isolates and four (40 %) C. krusei isolates. Resistance to 5-flucytosine was observed in two (0.8 %) C. albicans isolates, seven (9.3 %) C. tropicalis isolates, three (1.6 %) C. parapsilosis isolates and all ten (100 %) C. krusei isolates. All the isolates of C. albicans, C. tropicalis, C. parapsilosis, C. glabrata and C. krusei were susceptible to voriconazole, including those resistant to fluconazole. Although amphotericin B and fluconazole are widely used in clinical practice in Kuwait, resistance to these drugs remained low. INTRODUCTIONCandida species are one of the major causes of nosocomial bloodstream infections worldwide (Jarvis, 1995;. Despite the availability of an expanded antifungal armamentarium, the mortality associated with invasive Candida infections remains high, ranging between 19 and 49 % (Blot et al., 2002;Alonso-Valle et al., 2003;Gudlaugsson et al., 2003;Morgan, 2005). The incidence and associated mortality due to candidaemia can be influenced by several factors including characteristics of the population at risk, standard of the healthcare facilities available, distribution of Candida species and prevalence of resistance (Hobson, 2003;Eggimann et al., 2003). Hence, epidemiological information available for one centre or geographical region may not be applicable to others (Hobson, 2003). The increased isolation rates of non-albicans Candida species and a gradual shift in the antifungal susceptibility profile, especially against azole antifungal agents, have underlined the need to monitor laboratory data for possible emergence of resistance and to select the most appropriate antifungal agent for therapy (Sanglard & Odds, 2002;Eggimann et al., 2003). C...

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