title: Increasing incidence of Candida parapsilosis candidemia with caspofungin usage.
abstract: OBJECTIVE
  To determine the impact on the change in epidemiology of Candida species at our institution since the introduction of caspofungin.
  
  
  METHODS
  A 5-year retrospective review of all candidemia at a major tertiary care center. Only one episode of candidemia per patient per admission was counted. All antifungal defined daily doses were also collected in this same time period. Regression analysis was performed on the data and correlation statistics among antifungal use and Candida species were assessed using a Pearson correlation analysis.
  
  
  RESULTS
  There were 469 individual episodes of candidemia between fiscal year 2002 and 2006 with the rate increasing every year. On regression analysis there was a significant increase in Candida parapsilosis candidemia (R(2)=0.90, p=0.02) and significant increase in caspofungin usage (R(2)=0.80, p<0.01), with a correspondingly significant decline in conventional (R(2)=-0.77, p<0.01) and lipid amphotericin B (R(2)=-0.95, p<0.05) usage. We found correlations between increased caspofungin usage (R(2)=0.94, p=0.017) and increased C. parapsilosis candidemia and decreased Candida tropicalis candidemia (R(2)=0.92, p<0.05) and a trend towards decreased Candida glabrata (R(2)=0.64, p=0.1).
  
  
  CONCLUSIONS
  We showed significant correlations between increased caspofungin usage and an increased incidence of C. parapsilosis candidemia and reduction in C. tropicalis candidemia, with a trend towards less C. glabrata candidemia.
authors: Division of Infectious Diseases, Department of Medicine, University of Maryland, 20 Penn Street, Room S403B, Baltimore, MD 21201, USA. gforrest@medicine.umaryland.edu
authors: Graeme N
authors: GN
authors: Forrest
authors: Elizabeth
authors: E
authors: Weekes
authors: Jennifer K
authors: JK
authors: Johnson
mesh_terms: D000046:Academic Medical Centers; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002175:Candida / Q000145:classification* / Q000187:drug effects / Q000302:isolation & purification*; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D000077336:Caspofungin; D025141:Drug Resistance, Fungal; D054714:Echinocandins / Q000494:pharmacology / Q000627:therapeutic use*; D015725:Fluconazole / Q000494:pharmacology / Q000627:therapeutic use; D016469:Fungemia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D015994:Incidence; D055666:Lipopeptides; D008396:Maryland; D008826:Microbial Sensitivity Tests; D012044:Regression Analysis
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D015725:Fluconazole; D000077336:Caspofungin