title: Epidemiology and outcomes of invasive candidiasis due to non-albicans species of Candida in 2,496 patients: data from the Prospective Antifungal Therapy (PATH) registry 2004-2008.
abstract: This analysis describes the epidemiology and outcomes of invasive candidiasis caused by non-albicans species of Candida in patients enrolled in the Prospective Antifungal Therapy Alliance (PATH Alliance) registry from 2004 to 2008. A total of 2,496 patients with non-albicans species of Candida isolates were identified. The identified species were C. glabrata (46.4%), C. parapsilosis (24.7%), C. tropicalis (13.9%), C. krusei (5.5%), C. lusitaniae (1.6%), C. dubliniensis (1.5%) and C. guilliermondii (0.4%); 111 infections involved two or more species of Candida (4.4%). Non-albicans species accounted for more than 50% of all cases of invasive candidiasis in 15 of the 24 sites (62.5%) that contributed more than one case to the survey. Among solid organ transplant recipients, patients with non-transplant surgery, and patients with solid tumors, the most prevalent non-albicans species was C. glabrata at 63.7%, 48.0%, and 53.8%, respectively. In 1,883 patients receiving antifungal therapy on day 3, fluconazole (30.5%) and echinocandins (47.5%) were the most frequently administered monotherapies. Among the 15 reported species, 90-day survival was highest for patients infected with either C. parapsilosis (70.7%) or C. lusitaniae (74.5%) and lowest for patients infected with an unknown species (46.7%) or two or more species (53.2%). In conclusion, this study expands the current knowledge of the epidemiology and outcomes of invasive candidiasis caused by non-albicans species of Candida in North America. The variability in species distribution in these centers underscores the importance of local epidemiology in guiding the selection of antifungal therapy.
authors.affiliation: JMI Laboratories, North Liberty, Iowa, United States of America; Department of Pathology, University of Iowa, Iowa City, Iowa, United States of America.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Pfaller
authors.affiliation: Department of Medicine, University of Wisconsin, Madison, Wisconsin, United States of America.
authors.forename: David R
authors.initials: DR
authors.lastname: Andes
authors.affiliation: Department of Pathology, University of Iowa, Iowa City, Iowa, United States of America.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Diekema
authors.affiliation: David Horn LLC, Doylestown, Pennsylvania, United States of America.
authors.forename: David L
authors.initials: DL
authors.lastname: Horn
authors.affiliation: Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, United States of America.
authors.forename: Annette C
authors.initials: AC
authors.lastname: Reboli
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Coleman
authors.initials: C
authors.lastname: Rotstein
authors.affiliation: Astellas Scientific and Medical Affairs, Northbrook, Illinois, United States of America.
authors.forename: Billy
authors.initials: B
authors.lastname: Franks
authors.affiliation: Astellas Scientific and Medical Affairs, Northbrook, Illinois, United States of America.
authors.forename: Nkechi E
authors.initials: NE
authors.lastname: Azie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002175:Candida / Q000187:drug effects* / Q000302:isolation & purification; D058365:Candidiasis, Invasive / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D015725:Fluconazole / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D015725:Fluconazole