Candida krusei fungaemia: antifungal susceptibility and clinical presentation of an uncommon entity during 15 years in a single general hospital.
BACKGROUND
Candida krusei fungaemia is an uncommon entity described in immunocompromised patients previously exposed to azole agents.


METHODS
From 1988 to 2003, 13 episodes of C. krusei fungaemia (2.3% of all fungaemias) were detected in our institution and compared with 39 Candida albicans controls. Susceptibility testing was carried out with the modified microdilution method according to NCCLS recommendations.


RESULTS
Underlying conditions were: HIV infection (4), haematological malignancies (4), organ transplantation (2), abdominal surgery (2) and lactose intolerance (1). Nine patients (69%) were not neutropenic. In comparison with C. albicans, patients with C. krusei infection had more commonly received antifungal agents (54% versus 15%, P = 0.006), had a haematological disease (31% versus 3%, P = 0.03), or a transplant (15% versus 3%, P = 0.08), were on corticosteroids (47% versus 13%, P = 0.01) and were neutropenic (31% versus 0%, P < 0.001). Patients with C. albicans had more surgical interventions (41% versus 15%, P = 0.09) and bladder catheters (61% versus 31%, P = 0.05). The most common origin for C. albicans was a catheter (41% versus 0%; P = 0.006) whereas for C. krusei the most common origin was unknown (69% versus 20%; P = 0.001). C. krusei presented more commonly with skin lesions in neutropenic patients (23% versus 5%; P = 0.05). Multivariate analysis of these differential characteristics showed that the only factor that independently predicted the presence of C. krusei fungaemia was the administration of antifungal agents before the fungaemia (RR: 6.4; P=0.009; 95%CI 1.6-25.99). Overall mortality of C. krusei fungaemia was 38% (C. albicans 49%). Except for voriconazole (MIC90 0.125 mg/L), azoles and 5-flucytosine had poor activity against C. krusei, whereas amphotericin (MIC90 1 mg/L) and LY-303366 (MIC90 0.06 mg/L) showed good activity.


CONCLUSIONS
C. krusei fungaemia incidence remains low despite widespread use of azoles. It may occur outside the setting of cancer patients with previous antifungal use. The presence of skin lesions should be a warning sign.
Muñoz
Patricia
P
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 47, 28006 Madrid, Spain. pmunoz@micro.hggm.es
Sánchez-Somolinos
Mar
M
Alcalá
Luis
L
Rodríguez-Créixems
Marta
M
Peláez
Teresa
T
Bouza
Emilio
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002175:Candida / Q000187:drug effects* / Q000302:isolation & purification; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D025141:Drug Resistance, Fungal / Q000187:drug effects* / Q000502:physiology; D005260:Female; D006769:Hospitals, General; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis
D000935:Antifungal Agents