title: Emergence of azole-resistant Candida parapsilosis causing bloodstream infection: results from laboratory-based sentinel surveillance in South Africa.
abstract: To compare Candida species distribution and antifungal susceptibility at South African public- and private-sector hospitals.
  
  
  
  From February 2009 through to August 2010, laboratory-based surveillance for candidaemia was undertaken at 11 public-sector hospitals and >85 private-sector hospitals across South Africa. A case was defined as a patient of any age admitted to a sentinel hospital with isolation of Candida species from blood culture. Viable isolates were identified and tested for antifungal susceptibility at a reference laboratory. Demographic and limited clinical data were abstracted from laboratory records.
  
  
  
  In total, 2172 cases of candidaemia were detected. Among patients with available data, almost two-thirds were critically ill (719/1138, 63%). On multivariable analysis, neonates [adjusted OR (aOR), 2.2; 95% CI, 1.5-3.1; P < 0.001] and patients diagnosed in Gauteng province (aOR, 1.9; 95% CI, 1.3-2.7; P < 0.001) or in the private sector (aOR, 1.9; 95% CI, 1.2-3.2; P = 0.008) were significantly more likely to be infected with Candida parapsilosis than any other Candida species. Of 531 C. parapsilosis isolates, only 199 (37%) were susceptible to fluconazole and voriconazole; 44% (123/282) of fluconazole-resistant isolates were voriconazole cross-resistant. Factors associated with fluconazole non-susceptible C. parapsilosis infection on multivariable analysis included diagnosis in Gauteng province (aOR, 4.2; 95% CI, 2.7-6.7; P < 0.001), an ICU (aOR, 2.3; 95% CI, 1.5-3.6; P < 0.001) or the private sector (aOR, 2.2; 95% CI, 1.4-3.5; P < 0.001).
  
  
  
  The dominance of triazole non-susceptible C. parapsilosis limits the choice of antifungal agents for management of candidaemia among critically ill neonates, children and adults in resource-limited South African hospitals.
authors.affiliation: National Institute for Communicable Diseases-Centre for Opportunistic, Tropical and Hospital Infections, a Division of the National Health Laboratory Service, Johannesburg, South Africa Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa neleshg@nicd.ac.za.
authors.forename: Nelesh P
authors.initials: NP
authors.lastname: Govender
authors.affiliation: National Institute for Communicable Diseases-Centre for Opportunistic, Tropical and Hospital Infections, a Division of the National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Jaymati
authors.initials: J
authors.lastname: Patel
authors.affiliation: National Institute for Communicable Diseases-Centre for Opportunistic, Tropical and Hospital Infections, a Division of the National Health Laboratory Service, Johannesburg, South Africa Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Rindidzani E
authors.initials: RE
authors.lastname: Magobo
authors.affiliation: National Institute for Communicable Diseases-Centre for Opportunistic, Tropical and Hospital Infections, a Division of the National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Serisha
authors.initials: S
authors.lastname: Naicker
authors.affiliation: Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Chris Hani Baragwanath Hospital, National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Wadula
authors.affiliation: Tygerberg Hospital, National Health Laboratory Service and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: Andrew
authors.initials: A
authors.lastname: Whitelaw
authors.affiliation: Inkosi Albert Luthuli Hospital, National Health Laboratory Service and Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Yacoob
authors.initials: Y
authors.lastname: Coovadia
authors.affiliation: Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Helen Joseph Hospital, National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Ranmini
authors.initials: R
authors.lastname: Kularatne
authors.affiliation: Lancet Laboratories, Durban, South Africa.
authors.forename: Chetna
authors.initials: C
authors.lastname: Govind
authors.affiliation: Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Shawn R
authors.initials: SR
authors.lastname: Lockhart
authors.affiliation: Ampath National Laboratory Service, Johannesburg, South Africa.
authors.forename: Inge L
authors.initials: IL
authors.lastname: Zietsman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001393:Azoles / Q000494:pharmacology*; D002175:Candida / Q000145:classification* / Q000187:drug effects* / Q000302:isolation & purification; D058387:Candidemia / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D025141:Drug Resistance, Fungal; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018571:Sentinel Surveillance; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001393:Azoles