[Prevalence of Candida parapsilosis, C. orthopsilosis and C. metapsilosis in candidemia over a 5-year period at Nantes hospital and in vitro susceptibility to three echinocandins by E-test®].
OBJECTIVE
To determine the prevalence of C. parapsilosis sensu stricto, C. orthopsilosis and C. metapsilosis among candidemia at Nantes University Hospital and to evaluate the in vitro susceptibility of the isolates against three echinocandin drugs (caspofungin, micafungin and anidulafungin).


METHODS
Retrospective study (march 2004 to july 2009) of 178 cases of candidemia corresponding to 183 Candida spp. strains identified by means of routine phenotypical methods. Re-identification of C. parapsilosis sensu lato isolates was performed by ITS rDNA sequencing analysis. Minimal inhibitory concentrations (MIC) were determined by E-test(®). All echinocandin non-susceptible isolates (MIC>2 μg/mL) were analyzed for the presence/absence of FKS1 mutations associated with resistance.


RESULTS
During this period, C. parapsilosis sensu lato was responsible for 27 candidemia, ranging at the second most common Candida species after C. albicans (n=99, 54.1%). Neither isolates belong to C. orthopsilosis nor C. metapsilosis. According to the literature, all the isolates displayed high MICs against the three echinocandin drugs. All the isolates displayed both susceptibility (MIC ≤ 2 μg/mL) and a good agreement between MICs read at 24h and 48 h for caspofungin and micafungin (MIC(50)=0.75 μg/mL, MIC(90)=1.5 μg/mL). Surprisingly, whereas most of the strains were susceptible to anidulafungin at 24h (MIC(50)=1 μg/mL, MIC(90)=1.5 μg/mL), 14 (52 %) displayed non-susceptibility, despite the lack of mutation associated with resistance on FKS1, when reading was performed at 48 h (MIC(50)=3 μg/mL, MIC(90)=12 μg/mL).


CONCLUSIONS
Prevalence of C. orthopsilosis and C. metapsilosis in patients with candidemia is low at Nantes University Hospital. The difficulty encountered with MIC reading by E-test(®) are discussed.
Thierry
G
G
Laboratoire de parasitologie-mycologie, CHU Hôtel-Dieu, 9, quai Moncousu, 44093 Nantes cedex 01, France.
Morio
F
F
Le Pape
P
P
Gay-Andrieu
F
F
Barre
O
O
Miegeville
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077612:Anidulafungin; D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification; D058387:Candidemia / Q000453:epidemiology* / Q000382:microbiology; D000077336:Caspofungin; D002648:Child; D002675:Child, Preschool; D025141:Drug Resistance, Fungal / Q000235:genetics; D054714:Echinocandins / Q000494:pharmacology*; D005260:Female; D005602:France / Q000453:epidemiology; D005656:Fungal Proteins / Q000235:genetics / Q000502:physiology; D016695:Glycosyltransferases / Q000235:genetics / Q000502:physiology; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D066298:In Vitro Techniques; D007223:Infant; D007231:Infant, Newborn; D055666:Lipopeptides / Q000494:pharmacology*; D008297:Male; D000077551:Micafungin; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D021521:Ribotyping; D013045:Species Specificity; D055815:Young Adult
D000935:Antifungal Agents; D054714:Echinocandins; D005656:Fungal Proteins; D055666:Lipopeptides; D000077612:Anidulafungin; D016695:Glycosyltransferases; D000077336:Caspofungin; D000077551:Micafungin