title: Candidemia surveillance in Iowa: emergence of echinocandin resistance.
abstract: We performed prospective surveillance for candidemia at 14 Iowa hospitals in 2011-2012. A total of 163 episodes were analyzed. Candida albicans (n = 69 [42%]) and Candida glabrata (n = 58 [36%]) were the most common species. Antifungal resistance was uncommon; 9% of C. glabrata were fluconazole resistant, and 5% (3 isolates) were intermediate or resistant to 1 or more of the echinocandins. Molecular analyses of the fks1 and fks2 hotspots of the C. glabrata revealed no mutations except in 2 of these 3 isolates (L628R and S629P in fks1). Compared with previous surveillance performed in 1998-2001, there was a decrease in proportion of candidemia due to C. albicans (58 to 42%) and an increased proportion due to C. glabrata (20 to 36%). Further emergence of echinocandin resistance among the increasingly common species C. glabrata would complicate the management of this life-threatening infection.
authors.affiliation: Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52246.
authors.forename: Eiyu
authors.initials: E
authors.lastname: Matsumoto
authors.affiliation: Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52246.
authors.forename: Linda
authors.initials: L
authors.lastname: Boyken
authors.affiliation: Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52246.
authors.forename: Shailesh
authors.initials: S
authors.lastname: Tendolkar
authors.affiliation: Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52246.
authors.forename: Jennifer
authors.initials: J
authors.lastname: McDanel
authors.affiliation: JMI Laboratories, North Liberty, IA.
authors.forename: Mariana
authors.initials: M
authors.lastname: Castanheira
authors.affiliation: Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52246; JMI Laboratories, North Liberty, IA.
authors.forename: Michael
authors.initials: M
authors.lastname: Pfaller
authors.affiliation: Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52246; Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52246. Electronic address: daniel-diekema@uiowa.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Diekema
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; D058387:Candidemia / Q000453:epidemiology* / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D025141:Drug Resistance, Fungal; D054714:Echinocandins / Q000494:pharmacology*; D062665:Epidemiological Monitoring; D005260:Female; D015725:Fluconazole / Q000494:pharmacology; D005656:Fungal Proteins / Q000235:genetics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007484:Iowa / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009154:Mutation; D015995:Prevalence; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D005656:Fungal Proteins; D015725:Fluconazole
keywords: Antifungal resistance; Bloodstream infection; Candida; Echinocandin; Surveillance