Candidaemia in Immune-Compromised Hosts: Incidence and Drugs Susceptibility

We analyzed the different Candidae species isolated from bloodstream infections and the related antifungal susceptibility pattern over a five year period (2007-2011) at Policlinico Umberto I of Rome (Italy). The overall incidence of candidaemia during this range of time accounted for 6.4% with a marked increase from 2007 to 2011 (from 3.83% to 9%). The species isolated were the following: C. albicans (42%) and non-albicans (58%). In the period 2007-2009, C.krusei was the most frequent species detected among non-albicans species (29.4%),followed by C.glabrata (20%), whereas during 2010-2011 we found a shift versus C. parapsilosis increasing from 4.6% to 33%. C.albicans showed a good susceptibility to the most antifungal agents. C. krusei exhibited a raising resistance to flucytosin and fluconazole. As for fluconazole, it shows an intrinsic resistance. In C. glabrata we observed increased resistance especially to fluconazole for which this species shows a susceptibility dose-dependent (SDD). C.tropicalis had only a resistance to fluconazole (MIC90%=16 mcg/ml) In vitro activity of the echinocandins resulted to be very strong for all Candidae species. These drugs have a fungicidal activity and their use is recommended in the most severe diseases.Our study confirms the high incidence of candidaemia in the setting of critically ill patients. A strong association of Candidae infection with the presence of Central Venous Catheter(CVC) has been markedly noticed especially in the years 2009 and 2011 due to a greater use of CVC in our patients. The overall rate of resistance increased over the study period in all Candidae strains.