title: Candida tropicalis bloodstream infection: Incidence, risk factors and outcome in a population-based surveillance.
abstract: OBJECTIVE
  To assess the current clinical features and determinants of outcome of Candida tropicalis bloodstream infection (BSI).
  
  
  METHODS
  A population-based surveillance on Candida BSI was conducted from May 2010 to April 2011 in 29 Spanish hospitals. Antifungal susceptibility testing (EUCAST methodology) was centrally performed. The characteristics and outcome of C. tropicalis BSI episodes were compared with those due to other species.
  
  
  RESULTS
  Fifty-nine out of 752 episodes (7.8%) were due to C. tropicalis (annual incidence: 0.62 cases per 100,000 population). Resistance to fluconazole and voriconazole was found in 23.2% and 26.8% of isolates. Breakthrough BSI occurred in 10.5% of episodes. Risk factors for C. tropicalis BSI were age (odds ratio [OR]: 1.01; P-value = 0.05), underlying leukaemia (OR: 4.77; P-value = 0.001) and chronic lung disease (OR: 2.62; P-value = 0.002). There were no differences in clinical failure (persistent BSI for ≥72 h after initiation of therapy and/or 30-day all-cause mortality) between C. tropicalis (39.6%) and non-C. tropicalis groups (45.6%). The appropriateness of antifungal therapy or the fluconazole MIC values had no significant impact on outcome, whereas early central venous catheter removal exerted a protective effect.
  
  
  CONCLUSIONS
  C. tropicalis BSI was associated with advanced age, haematological malignancy and respiratory comorbidity. We found no correlation between the unexpectedly high resistance rate to azoles observed and outcome.
authors.affiliation: Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Madrid, Spain. Electronic address: mario_fdezruiz@yahoo.es.
authors.forename: Mario
authors.initials: M
authors.lastname: Fernández-Ruiz
authors.affiliation: Department of Infectious Diseases, Hospital Universitari "Vall d'Hebron", Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Puig-Asensio
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario "Gregorio Marañón", Universidad Complutense, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Guinea
authors.affiliation: Department of Infectious Diseases, Hospital Universitari "Vall d'Hebron", Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Benito
authors.initials: B
authors.lastname: Almirante
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario "Gregorio Marañón", Universidad Complutense, Madrid, Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Padilla
authors.affiliation: Department of Microbiology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Almela
authors.affiliation: Clinical Unit of Critical Care and Emergency Medicine, Hospital Universitario "Virgen del Rocío", Sevilla, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Díaz-Martín
authors.affiliation: Clinical Unit of Infectious Diseases and Microbiology, Hospital Universitario "Virgen Macarena", Sevilla, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodríguez-Baño
authors.affiliation: Department of Mycology, Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Cuenca-Estrella
authors.affiliation: Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Universidad Complutense, Madrid, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Aguado
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D041022:Candida tropicalis / Q000187:drug effects*; D058387:Candidemia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D062905:Central Venous Catheters / Q000009:adverse effects; D015897:Comorbidity; D025141:Drug Resistance, Fungal; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007938:Leukemia / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D065819:Voriconazole / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole; D065819:Voriconazole
keywords: Candida tropicalis bloodstream infection; Epidemiology; Minimum inhibitory concentration; Outcome; Treatment