Species distribution and antifungal susceptibility of blood Candida isolates at a tertiary hospital in southern Taiwan, 1999-2006

Abstract

The aim of this study was to evaluate the incidence of candidaemia, consumption of fluconazole and susceptibility of blood Candida isolates at a tertiary hospital. From January 1999 to September 2006, all candidaemic episodes were identified and available strains were evaluated for the susceptibilities of antifungal agents. Annual defined daily doses of antifungal agents were collected. There had been 909 Candida isolates detected from the bloodstream of 843 patients during the study period. Among them, 740 isolates were available for the susceptibilities of antifungal agents. The incidence density of candidaemia was 28 episodes per 10,000 patient-days. Species distribution of 909 isolates did not vary annually, but varied greatly in the units of the hospital. Candida parapsilosis was the more prominent (30.1%) isolate in the paediatric units, where C. tropicalis and C. glabrata were less common (12.3% and 1.4% respectively). Resistance rates for itraconazole, fluconazole and voriconazole were 6.9%, 3.8% and 3.8% respectively. There were 25 (3.4%) isolates resistant to amphotericin-B. Although fluconazole usage increased over time (r(2) = 0.45; P = 0.07), fluconazole resistance did not increase accordingly (P = 0.33). In our institution in which the incidence of candidaemia was high, fluconazole resistance among blood Candida isolates remained rare.

Antifungal susceptibility of Candida species isolated from patients with candidemia in southern Taiwan, 2007–2012: impact of new antifungal breakpoints

“…As a result, our study may fail to demonstrate a correlation between fluconazole usage and the percentage of fluconazole non-susceptible isolates, given the rate of azole non-susceptible increasing only from 1% to 5% within the study period. Despite considerable variations in fluconazole consumption, fluconazole resistance rate still remains less than 10% among the Candida isolates in Taiwan 12,28. Similarly, our study was unable to demonstrate any association between echinocandins consumption and Candida species echinocandins non-susceptible rate owing to relative low echinocandins non-susceptible rate of Candida species observed in this study.This study has some limitations.…”

“…Chen et al . reported that poor correlation between consumption of fluconazole and changes of azole resistance over a 8‐year study period.…”

“…This study of the clinical bloodstream Candida strains in southern Taiwan revealed the revised breakpoints affected markedly in (i) fluconazole and voriconazole against C. tropicalis, (ii) anidulafungin and caspofungin against C. tropicalis and C. glabrata and (iii) caspofungin against C. krusei. Further studies are needed to confirm the clinical relevance.Chen et al28 reported that poor correlation between consumption of fluconazole and changes of azole resistance over a 8-year study period. The consumption of fluconazole in our institution was steady over the study period and lower than that of study conducted by Chen 28.…”

“…Further studies are needed to confirm the clinical relevance.Chen et al28 reported that poor correlation between consumption of fluconazole and changes of azole resistance over a 8-year study period. The consumption of fluconazole in our institution was steady over the study period and lower than that of study conducted by Chen 28. As a result, our study may fail to demonstrate a correlation between fluconazole usage and the percentage of fluconazole non-susceptible isolates, given the rate of azole non-susceptible increasing only from 1% to 5% within the study period.…”

Loss of Heterozygosity of FCY2 Leading to the Development of Flucytosine Resistance in Candida tropicalis

“…Candida glabrata appears to be the most frequently isolated non-albicans Candida species in Western countries, whereas, in Asia, it is Candida tropicalis (4,7,28,36,40,41). In certain regions, it even surpassed C. albicans to become the most frequently isolated Candida species (4,40).…”