title: Recent experience with fungaemia: change in species distribution and azole resistance.
abstract: Owing to a rise in frequency and change in pattern of cases with fungaemia at our tertiary care centre, we conducted a prospective study for 4 months to understand the epidemiology and outcome of this infection. Detailed case histories including management protocol and outcomes were noted. Records of 140 cases with fungaemia (27.1% adult and 72.9% paediatric patients) were analysed. Although C. tropicalis was the most common yeast isolated, significantly higher isolation of C. guilliermondii (30.4%) and C. pelliculosa (17.6%) was noted in paediatric patients; and C. albicans (26.3%) and C. glabrata (10.5%) in adult patients. Rare species isolated included C. ustus (0.7%) and Trichosporon asahii (2.1%). Mortality was high (56.9% and 47.4%, respectively), in both groups of patients. Resistance to azoles (fluconazole, itraconazole, voriconazole) emerged in C. albicans (12.5-18.8%) and C. tropicalis (10.2-13.6%). Antifungal susceptibility testing report modified the therapy from fluconazole to amphotericin B in 8 patients; 5 survived. In conclusion, the study highlighted the rise of non-albicans Candida species in our hospital with differential distribution in paediatric and adult wards and emergence of azole resistance.
authors.affiliation: Departments of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012,India. arunaloke@hotmail.com
authors.forename: Arunaloke
authors.initials: A
authors.lastname: Chakrabarti
authors.forename: Shiv Sekhar
authors.initials: SS
authors.lastname: Chatterjee
authors.forename: K L N
authors.initials: KL
authors.lastname: Rao
authors.forename: M M
authors.initials: MM
authors.lastname: Zameer
authors.forename: M R
authors.initials: MR
authors.lastname: Shivaprakash
authors.forename: Sunit
authors.initials: S
authors.lastname: Singhi
authors.forename: Rajinder
authors.initials: R
authors.lastname: Singh
authors.forename: Shubhash Chandra
authors.initials: SC
authors.lastname: Varma
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000145:classification* / Q000187:drug effects / Q000302:isolation & purification; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D002648:Child; D025141:Drug Resistance, Fungal; D016469:Fungemia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D007194:India / Q000453:epidemiology; D012307:Risk Factors; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*
chemical_list: D000935:Antifungal Agents; D014230:Triazoles