[Emergence of Candida parapsilosis candidemia at Cochin hospital. Characterization of isolates and search for risk factors].
Candida parapsilosis is a normal saprophyte of the skin, characterized by their affinity for catheters. This species has, in vitro, a level of sensitivity against the echinocandins, significantly lower than that observed with other Candida species. Recently, new species: Candida orthopsilosis and Candida metapsilosis, phenotypically identical to C. parapsilosis, have been identified by molecular biology. From 2003 to 2007, in the Cochin hospital, the proportion of C. parapsilosis among non-albicans species isolated from blood cultures increased from 17 (3/18) to 38% (5/13). To understand the reasons for this emergence, we retrospectively characterized isolates, conducted a case-control and researched a link between the emergence and introduction of caspofungin in our hospital. We analysed data from 26 patients who had candidemia with C. parapsilosis. Genotypic analysis of isolates has not identified the new species C. orthopsilosis and C. metapsilosis. The case-control study showed a broad-spectrum antibiotics was significantly more frequent for candidemia with C. parapsilosis compared to C. albicans (52 versus 26%, P=0.04) as a previous treatment with caspofungin (11 versus 0%, P=0.04). The introduction of caspofungin is contemporary with the emergence of candidemia with C. parapsilosis with a tendency to be related to its level of consumption in the ICU. Our results should encourage biologists to closely monitor the frequency and level of sensitivity of strains of C. parapsilosis isolated in hospital.
Paugam
A
A
Service de parasitologie-mycologie, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France. andre.paugam@cch.aphp.fr
Baixench
M-T
MT
Taieb
F
F
Champagnac
C
C
Dupouy-Camet
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification*; D058387:Candidemia / Q000453:epidemiology* / Q000382:microbiology; D016022:Case-Control Studies; D000077336:Caspofungin; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004198:Disease Susceptibility; D025141:Drug Resistance, Fungal; D004363:Drug Utilization / Q000706:statistics & numerical data; D054714:Echinocandins / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D055666:Lipopeptides; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010297:Paris / Q000453:epidemiology; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D013045:Species Specificity; D055815:Young Adult
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077336:Caspofungin