Trends in candidemia and antifungal susceptibility in a university hospital in Northern Ireland 2001-2006.
OBJECTIVE
To describe the species distribution and antifungal susceptibility trends for documented episodes of candidemia at the Royal Hospitals, Belfast, 2001-2006.


METHODS
Laboratory-based retrospective observational study of all episodes of candidemia.


RESULTS
There were 151 episodes of candidemia. The species recovered were: 96 C. albicans; 26 C. glabrata; 18 C. parapsilosis; five C. tropicalis; four C. guilliermondii; one C. famata and one C. dubliniensis. We separated the data into two periods 2001-2003 and 2004-2006; contrary to the findings of other investigators, there was a notable trends toward increasing frequency of C. albicans and decreasing frequency of non-albicans species over time. Although the proportion of C. albicans, C. parapsilosis and C. tropicalis isolates susceptible to fluconazole was unchanged over time, a trend of decreased susceptibility of C. glabrata to fluconazole was noted over the six-year period. Overall, 73% and 7.7% of C. glabrata isolates had susceptible-dose-dependent and resistant phenotypes, respectively. The percentage of C. glabrata isolates susceptible to fluconazole (MIC <8 microg/ml) decreased from 36% in 2001-2003 to 0% in 2004-2006. Flucytosine resistance was detected in only 4 (2.7%) isolates. None of the isolates had an amphotericin B MIC <1 microg/ml.


CONCLUSIONS
A shift towards increasing dominance of C. albicans contrasts both with reports from other countries and previous data from Northern Ireland. Upwards fluconazole MIC drift among C. glabrata has important implications for empirical therapeutic decisions.
Metwally
L
L
Department of Medical Microbiology, The Royal Hospitals, School of Medicine and Dentistry, Belfast, Northern Ireland. lobna.metwally@belfasttrust.hscni.net
Walker
M J
MJ
Coyle
P V
PV
Hay
R J
RJ
Hedderwick
S
S
McCloskey
B V
BV
O'Neill
H J
HJ
Webb
C H
CH
McMullan
R
R
D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D041221:Candida glabrata / Q000187:drug effects; D002177:Candidiasis / Q000145:classification* / Q000188:drug therapy / Q000453:epidemiology; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D016347:Medical Records Systems, Computerized; D008826:Microbial Sensitivity Tests; D009660:Northern Ireland / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies
D000935:Antifungal Agents