Epidemiology, species distribution, and in vitro antifungal susceptibility of fungaemia in a Spanish multicentre prospective survey

Pemán J, Cantón E, Quindós G, Eraso E, Alcoba J, Guinea J, Merino P, Ruiz-Pérez-de-Pipaon MT, Pérez-del-Molino L, Linares-Sicilia MJ, Marco F, García J, Roselló EM, Gómez-G-de-la-Pedrosa E, Borrell N, Porras A, Yagüe G and the FUNGEMYCA Study Group. Epidemiology, species distribution, and in vitro antifungal susceptibility of fungaemia in a Spanish multicentre prospective survey. Journal of Antimicrobial Chemotherapy 2012

Summary
Objective: To update the knowledge on the epidemiology, species implicated and in vitro antifungal susceptibilities of fungaemia episodes in Spain.
Methods: Episodes were identified prospectively over 13 months at 44 Spanish hospitals. Molecular methods were used to determine the cryptic species inside the Candida parapsilosis-complex and Candida glabrata-group. Susceptibility to amphotericin B, anidulafungin, caspofungin, fluconazole, flucytosine, itraconazole, micafungin, posaconazole and voriconazole was determined by microdilution colorimetric method. New species-specific clinical breakpoints for echinocandins, fluconazole and voriconazole were applied.
Results: Incidence of the 1,357 fungaemia episodes evaluated was 0.92 per 1,000 admissions. Candida albicans fungaemia was the most frequent (0.41) followed by Candida parapsilosis sensu stricto (0.22). Candida orthopsilosis was the fifth cause of fungaemia (0.02), outnumbered by Candida glabrata and Candida tropicalis. Fungaemia was more frequent in non-ICU settings (65.2%) and among elderly patients (46.4%), being mixed fungaemia incidental (1.5%). Presence of intravascular catheter (66.7%), surgery (39.9%), neutropaenia (9.1%), and haematopoietic stem cell transplantation (5.8%) were the most frequent predisposing factors. Fluconazole-susceptible species accounted for 1,173 out of 1,377 isolates (85.19%). C. glabrata and Candida krusei were highly susceptible to anidulafungin, micafungin and voriconazole (>95% of isolates). Overall, 88.9% of yeast isolates were susceptible to all antifungal agents tested.
Conclusions: Fungaemia was more common in non-critical patients. C. albicans was the most frequent species followed by C. parapsilosis, C. glabrata, C. tropicalis and C. orthopsilosis. Important resistance rates were only observed in C. glabrata for itraconazole (24.1%) and posaconazole (14.5%), and in C. krusei for itraconazole (81.5%).