title: Species distribution and antifungal susceptibility of bloodstream fungal isolates in paediatric patients in Mexico: a nationwide surveillance study.
abstract: OBJECTIVE
  To establish the species distribution and in vitro susceptibilities of 358 bloodstream fungal isolates from paediatric patients in Mexico.
  
  
  METHODS
  Isolates were collected during a 2 year surveillance programme in 14 medical centres in 10 Mexican states. A molecular approach was used to determine the Candida parapsilosis species complex. In vitro susceptibility to amphotericin B, fluconazole, voriconazole, itraconazole, posaconazole, caspofungin, anidulafungin and micafungin was determined according to CLSI procedures. Species-specific clinical breakpoints for fluconazole, voriconazole and echinocandins were applied.
  
  
  RESULTS
  Candida spp. accounted for 98.33% of fungaemias, including 127 Candida albicans isolates, 127 C. parapsilosis complex isolates (121 C. parapsilosis sensu stricto, 4 Candida orthopsilosis and 2 Candida metapsilosis strains) and 72 Candida tropicalis isolates. C. albicans and C. parapsilosis complex were the species predominant in neonates (48 cases each; 41.02%). C. parapsilosis complex was also the predominant species in patients 1 month to <2 years of age (P = 0.007). In contrast, C. albicans was the most frequent species in patients aged 2 to <12 years (P = 0.003). Antifungal resistance was rare among the subset of isolates. Candida glabrata showed the highest resistance rate to amphotericin B (1/9 isolates), fluconazole (1/9 isolates) and itraconazole (2/9 isolates).
  
  
  CONCLUSIONS
  The species distribution differed with the age of the patients, with C. albicans and C. parapsilosis complex being the most commonly isolated species. C. glabrata showed the highest resistance rate to amphotericin B, fluconazole and itraconazole. This is the first study of fungaemia episodes in Mexican children.
authors.affiliation: Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.
authors.forename: Gloria M
authors.initials: GM
authors.lastname: González
authors.forename: Rogelio de J
authors.initials: Rde J
authors.lastname: Treviño-Rangel
authors.forename: José P
authors.initials: JP
authors.lastname: Palma-Nicolás
authors.forename: César
authors.initials: C
authors.lastname: Martínez
authors.forename: J Gerardo
authors.initials: JG
authors.lastname: González
authors.forename: Jacobo
authors.initials: J
authors.lastname: Ayala
authors.forename: Amílcar
authors.initials: A
authors.lastname: Caballero
authors.forename: Rayo
authors.initials: R
authors.lastname: Morfín-Otero
authors.forename: E
authors.initials: E
authors.lastname: Rodríguez-Noriega
authors.forename: Fernando
authors.initials: F
authors.lastname: Velarde
authors.forename: Elba P
authors.initials: EP
authors.lastname: Ascencio
authors.forename: Juan C
authors.initials: JC
authors.lastname: Tinoco
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Vázquez
authors.forename: Manuel A
authors.initials: MA
authors.lastname: Cano
authors.forename: Nidia
authors.initials: N
authors.lastname: León-Sicairos
authors.forename: Rocío
authors.initials: R
authors.lastname: González
authors.forename: Joaquín
authors.initials: J
authors.lastname: Rincón
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Elías
authors.forename: Alexandro
authors.initials: A
authors.lastname: Bonifaz
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D062665:Epidemiological Monitoring; D005260:Female; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology*; D005658:Fungi / Q000187:drug effects* / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008826:Microbial Sensitivity Tests
chemical_list: D000935:Antifungal Agents
keywords: Candida albicans; Candida parapsilosis complex; Candida tropicalis; antifungal in vitro susceptibility; fungaemia