Journal de pathologie clinique et expérimentale

Abstrait

Candidaemia in Immune-Compromised Hosts: Incidence and Drugs Susceptibility

Maria T. Mascellino, Giammarco Raponi, Alessandra Oliva, Claudio M. Mastroianni and Vincenzo Vullo

Abstract
We analyzed the different Candidae species isolated from bloodstream infections and the related antifungal
susceptibility pattern over a five-year period (2007-2011) at Policlinico Umberto I of Rome (Italy).
The overall incidence of candidaemia during this range of time accounted for 6.4% with a marked increase from
2007 to 2011 (from 3.83% to 9%). The species isolated were the following: C. albicans (42%) and non-albicans (58%).
In the period 2007-2009, C.krusei was the most frequent species detected among non-albicans species (29.4%),
followed by C.glabrata (20%), whereas during 2010-2011 we found a shift versus C. parapsilosis increasing from 4.6%
to 33%.
C.albicans showed a good susceptibility to the most antifungal agents. C. krusei exhibited a raising resistance to
flucytosin and fluconazole. As for fluconazole, it shows an intrinsic resistance. In C. glabrata we observed increased
resistance especially to fluconazole for which this species shows a Susceptibility Dose-Dependent (SDD). C.tropicalis
had only a resistance to fluconazole (MIC 90%=16 mcg/ml) In vitro activity of the echinocandins resulted to be very
strong for all Candidae species. These drugs have a fungicidal activity and their use is recommended in the most
severe diseases.
Our study confirms the high incidence of candidaemia in the setting of critically ill patients. A strong association of
Candidae infection with the presence of Central Venous Catheter (CVC) has been markedly noticed especially in the
years 2009 and 2011 due to a greater use of CVC in our patients. The overall rate of resistance increased over the
study period in all Candidae strains.