title: Epidemiology, species distribution and in vitro antifungal susceptibility of fungaemia in a Spanish multicentre prospective survey.
abstract: OBJECTIVE
  To update the knowledge of the epidemiology of fungaemia episodes in Spain, the species implicated and their in vitro antifungal susceptibilities.
  
  
  METHODS
  Episodes were identified prospectively over 13 months at 44 hospitals. Molecular methods were used to determine the cryptic species inside the Candida parapsilosis and Candida glabrata complexes. Susceptibility to amphotericin B, anidulafungin, caspofungin, fluconazole, flucytosine, itraconazole, micafungin, posaconazole and voriconazole was determined by a microdilution colorimetric method. New species-specific clinical breakpoints (SSCBPs) for echinocandins, fluconazole and voriconazole were applied.
  
  
  RESULTS
  The incidence of the 1357 fungaemia episodes evaluated was 0.92 per 1000 admissions. The incidence of Candida albicans fungaemia was the highest (0.41 episodes/1000 admissions), followed by Candida parapsilosis sensu stricto (0.22). Candida orthopsilosis was the fifth cause of fungaemia (0.02), outnumbered by Candida glabrata and Candida tropicalis. Interestingly, the incidence of fungaemia by C. parapsilosis was 11 and 74 times higher than that by C. orthopsilosis and Candida metapsilosis, respectively. Neither Candida nivariensis nor Candida bracarensis was isolated. Fungaemia was more common in non-intensive care unit settings (65.2%) and among elderly patients (46.4%), mixed fungaemia being incidental (1.5%). Overall susceptibility rates were 77.6% for itraconazole, 91.9% for fluconazole and 96.5%-99.8% for the other agents. Important resistance rates were only observed in C. glabrata for itraconazole (24.1%) and posaconazole (14.5%), and in Candida krusei for itraconazole (81.5%).
  
  
  CONCLUSIONS
  Fungaemia is more common in non-critical patients. C. albicans is the most common species, followed by C. parapsilosis and C. glabrata. Nearly 90% of yeasts are susceptible to all antifungal agents tested. Resistance rates change moderately when applying the new SSCBPs.
authors.affiliation: Hospital Universitario La Fe, Valencia, Spain. peman_jav@gva.es
authors.forename: Javier
authors.initials: J
authors.lastname: Pemán
authors.forename: Emilia
authors.initials: E
authors.lastname: Cantón
authors.forename: Guillermo
authors.initials: G
authors.lastname: Quindós
authors.forename: Elena
authors.initials: E
authors.lastname: Eraso
authors.forename: Julia
authors.initials: J
authors.lastname: Alcoba
authors.forename: Jesús
authors.initials: J
authors.lastname: Guinea
authors.forename: Paloma
authors.initials: P
authors.lastname: Merino
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Ruiz-Pérez-de-Pipaon
authors.forename: Luisa
authors.initials: L
authors.lastname: Pérez-del-Molino
authors.forename: María José
authors.initials: MJ
authors.lastname: Linares-Sicilia
authors.forename: Francesc
authors.initials: F
authors.lastname: Marco
authors.forename: Julio
authors.initials: J
authors.lastname: García
authors.forename: Eva María
authors.initials: EM
authors.lastname: Roselló
authors.forename: Elia
authors.initials: E
authors.lastname: Gómez-G-de-la-Pedrosa
authors.forename: Nuria
authors.initials: N
authors.lastname: Borrell
authors.forename: Aurelio
authors.initials: A
authors.lastname: Porras
authors.forename: Genoveva
authors.initials: G
authors.lastname: Yagüe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000145:classification* / Q000187:drug effects* / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology* / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology*; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000935:Antifungal Agents