title: Epidemiology, risk factor, species distribution, antifungal resistance and outcome of Candidemia at a single French hospital: a 7-year study.
abstract: Candidemia remains a major cause of disease worldwide and is associated with a high mortality rate. We conducted a retrospective study of candidemia at Nantes Hospital, France, between 2004 and 2010. A total of 191 episodes (n = 188 patients) were reviewed. Incidence, demographics, risk factors, antifungal management, species identification, in vitro susceptibility and 12 weeks survival were analysed. Global incidence of candidemia was 0.37‰ admissions. Higher incidences were observed in haematology (6.65‰) and intensive care units (2‰). Central venous catheter and antibiotic exposure were the most frequent risk factors (77% and 76% respectively). Candida albicans was the predominant species (51.8%) followed by C. parapsilosis (14.5%), C. glabrata (9.8%), C. tropicalis (9.8%) and C. krusei (4.1%). However, species distribution differed significantly between medical units with frequency of C. tropicalis being higher in haematology compared to other medical units. Fluconazole and caspofungin were the main antifungals given as first-line therapy. Although not significant, 12 weeks mortality rate was 30.9%, being higher for C. tropicalis (44.4%) than for C. parapsilosis (16%). Acquired azole or echinocandin resistance was noted in some isolates, underlining the need for systematic antifungal susceptibility testing in patients with candidemia. These epidemiological findings will be of interest for antifungal stewardship at our hospital.
authors.affiliation: Département de Parasitologie et Mycologie Médicale, EA1155 - IICiMed, Faculté de Pharmacie, Université de Nantes, Nantes Atlantique Universités, Nantes, France.|Laboratoire de Parasitologie-Mycologie, CHU de Nantes, Nantes, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Tadec
authors.affiliation: Service de Maladies Infectieuses et Tropicales, CHU de Nantes, Nantes, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Talarmin
authors.affiliation: Service d'Hématologie Clinique, CHU de Nantes, Nantes, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gastinne
authors.affiliation: Service de Réanimation Médicale, CHU de Nantes, Nantes, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Bretonnière
authors.affiliation: Département de Parasitologie et Mycologie Médicale, EA1155 - IICiMed, Faculté de Pharmacie, Université de Nantes, Nantes Atlantique Universités, Nantes, France.|Laboratoire de Parasitologie-Mycologie, CHU de Nantes, Nantes, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Miegeville
authors.affiliation: Département de Parasitologie et Mycologie Médicale, EA1155 - IICiMed, Faculté de Pharmacie, Université de Nantes, Nantes Atlantique Universités, Nantes, France.|Laboratoire de Parasitologie-Mycologie, CHU de Nantes, Nantes, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Le Pape
authors.affiliation: Département de Parasitologie et Mycologie Médicale, EA1155 - IICiMed, Faculté de Pharmacie, Université de Nantes, Nantes Atlantique Universités, Nantes, France.|Laboratoire de Parasitologie-Mycologie, CHU de Nantes, Nantes, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Morio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002175:Candida / Q000145:classification* / Q000187:drug effects / Q000302:isolation & purification; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D025141:Drug Resistance, Fungal; D054714:Echinocandins / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D015725:Fluconazole / Q000494:pharmacology / Q000627:therapeutic use; D005602:France / Q000453:epidemiology; D006757:Hospital Units / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D015725:Fluconazole
keywords: Candida species; Candidemia; antifungal resistance; antifungal therapy; catheter removal; outcome; risk factor