title: Nosocomial bloodstream infections due to Candida spp. in the USA: species distribution, clinical features and antifungal susceptibilities.
abstract: Candida spp. are among the most frequent nosocomial pathogens, contributing significantly to morbidity and mortality. Longitudinal data on the epidemiology of Candida bloodstream infections (BSIs) are still limited. Isolates and clinical data from 1218 episodes of Candida BSI were prospectively collected from patients in 52 hospitals in the USA between 1998 and 2006. Susceptibilities to amphotericin B, flucytosine, fluconazole, posaconazole, voriconazole, anidulafungin, caspofungin and micafungin were determined for 1077 Candida isolates by the CLSI reference broth microdilution method using the recently published species-specific clinical breakpoints. Candida albicans was the most prevalent species (50.7%), followed by Candida parapsilosis (17.4%), Candida glabrata (16.7%) and Candida tropicalis (10.2%). The prevalence of non-albicans Candida spp. increased over time. Patients had a mean age of 51 years and a mean length of hospital stay prior to BSI of 22 days. The main underlying conditions were gastrointestinal (20.1%) and pulmonary (13.0%) diseases. Intravenous catheters (19.1%) and the urinary tract (8.0%) were the most frequently determined likely sources, whilst in the majority of patients (61.1%) no source could be identified. Overall mortality was 38.1%. Of the isolates studied, 0.8% of C. albicans, 100.0% of C. glabrata, 2.9% of C. parapsilosis and 4.9% of C. tropicalis were non-susceptible to fluconazole, and 0.6% of C. albicans, 5.0% of Candida krusei, 7.6% of C. parapsilosis and 9.8% of C. tropicalis were non-susceptible to voriconazole. All echinocandins showed good activity against most Candida spp., including the majority of C. parapsilosis isolates, but only 38.1% of C. glabrata tested susceptible to caspofungin.
authors.affiliation: Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstrasse 19-21, 50935 Cologne, Germany; Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University, Medical Center Box 980019, Richmond, VA 23298-0019, USA.
authors.forename: Hilmar
authors.initials: H
authors.lastname: Wisplinghoff
authors.affiliation: Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstrasse 19-21, 50935 Cologne, Germany.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ebbers
authors.affiliation: Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstrasse 19-21, 50935 Cologne, Germany.
authors.forename: Lea
authors.initials: L
authors.lastname: Geurtz
authors.affiliation: Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstrasse 19-21, 50935 Cologne, Germany.
authors.forename: Danuta
authors.initials: D
authors.lastname: Stefanik
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University, Medical Center Box 980019, Richmond, VA 23298-0019, USA.
authors.forename: Yvette
authors.initials: Y
authors.lastname: Major
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University, Medical Center Box 980019, Richmond, VA 23298-0019, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University, Medical Center Box 980019, Richmond, VA 23298-0019, USA.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Wenzel
authors.affiliation: Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstrasse 19-21, 50935 Cologne, Germany. Electronic address: harald.seifert@uni-koeln.de.
authors.forename: Harald
authors.initials: H
authors.lastname: Seifert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000145:classification* / Q000187:drug effects* / Q000302:isolation & purification; D058387:Candidemia / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Amphotericin; Echinocandins; Flucytosine; Risk factors; SCOPE; Triazoles