Candida glabrata fungaemia in a tertiary centre in Taiwan: antifungal susceptibility and outcomes.
The proportion of non-albicans candidaemia has increased during recent decades, especially Candida glabrata. We evaluated the antifungal susceptibility, clinical features and outcome of C. glabrata fungaemia treated in a tertiary centre in Taiwan. All episodes of C. glabrata fungaemia during 1999-2005 were identified from microbiology laboratory records and all C. glabrata isolates were subjected to antifungal susceptibility testing by the broth microdilution method. A total of 177 episodes of C. glabrata fungaemia were documented, accounting for 30% of the 598 episodes of candidaemia. A dramatic decline of C. glabrata causing candidaemia from 2003 (46.8%) to 2005 (15.8%) was noted, accompanied by decreased fluconazole consumption. The most common underlying diseases in these patients were cancer (49%), diabetes (34%) and renal failure (25%). The most common risk factors were central venous catheter use (88%), antimicrobial treatment (87%) and parenteral nutrition (51%). The 30-day all-cause mortality was 48.6%, but only 31% of patients were eventually discharged from the hospital. There was no significant survival difference between patients with C. glabrata and Candida albicans fungaemia. Rates of antifungal susceptibility were 63% for fluconazole, 93% for voriconazole, 96% for caspofungin, 98% for amphotericin B and 99% for flucytosine. The different levels of susceptibility to fluconazole (susceptible, susceptible-dose dependent and resistant) were not significantly associated with 30-day mortality.
Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan.
Sheng-Yuan
SY
Ruan
Yu-Tsung
YT
Huang
Chen-Chen
CC
Chu
Chong-Jen
CJ
Yu
Po-Ren
PR
Hsueh
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D041221:Candida glabrata / Q000187:drug effects*; D025141:Drug Resistance, Fungal; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D016469:Fungemia / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
D000935:Antifungal Agents; D015725:Fluconazole