Abstract :
[en] Objectives
The aim of this multicenter study was to gather epidemiological data on candidemia in the Belgian population. Another goal was to determine the time in real life setting for reporting to the treating physicians of the species involved and its antifungal susceptibility.
Methods
Prospective study in 29 Belgian hospitals. From March 1st, 2013 till February 28, 2014 the first Candida isolate from each episode of candidemia was included. Identification and susceptibility testing were performed according to local procedures and isolates were sent to the National Reference Lab with a completed case report form. Species identification was checked by MALDI-TOF mass spectrometry (MS) and ITS sequencing in case no reliable identification was obtained by MS. Antifungal susceptibility testing was performed according to EUCAST guidelines. The total number of patient admissions and hospitalization days during the study period was retrieved from each hospital.
Results
341 isolates were retrieved from 325 patients (53.2% male, median age 66 years, range 1-94 years) admitted to the ICU (34.4%), medical wards (30.8%), surgical wards (15.2%), onco-haematology (10.6%), pediatrics (3.0%), neonatology (1.7%) and other wards (4.3%).
The mean incidence rate of candidemia was 0.42 per 1,000 admissions (range 0.07 to 1.44) and 0.60 per 10,000 patient days (range from 0.11 to 2.03).
Candida albicans was the main cause of candidemia (51.9%), followed by Candida glabrata (26.7%), Candida parapsilosis (9.9%), Candida tropicalis (4.4%), Candida guilliermondii (2.6%), Candida dubliniensis (1.5%), Candida lusitaniae (1.2%), Candida krusei (1.2%) and Candida metapsilosis (0.6%).
Overall resistance to fluconazole was 6.7% and to anidulafungin 0.6% (2 C. glabrata isolates were echinocandin resistant). Resistance to amphotericin B was detected in 1 C. tropicalis isolate, all C. albicans, C. glabrata and C. parapsilosis isolates remained susceptible to this drug. Resistance to fluconazole ranged from 3.5% in C. albicans, 8.6% in C. glabrata, 5.6% in C. parapsilosis to 35.7% (5/14 isolates) in C. tropicalis. These five C. tropicalis isolates showed cross resistance to voriconazole and posaconazole. MIC values for caspofungin ranged from <0,016 to >8mg/L, with MIC50 of 0.06mg/L and MIC90 of 0.25mg/L.
The median time between blood sampling and positivity of the blood culture bottle was
37h07min (Q1-Q3: 25h42min-54h28min). The median time between blood culture positivity and reporting of isolate identification and susceptibility to the treating physician was 29h58min (Q1-Q3: 23h21min-40h34min) and 59h34min (Q1-Q3: 48h28min-75h20min) respectively.
Conclusions
A large variation in the incidence of candidemia among Belgian hospitals was observed. Resistance to azole drugs remained low but emerging resistance to these drugs among C. tropicalis was noted. Resistance to echinocandins remains rare in Belgian Candida isolates. These data will be further analyzed in order to evaluate the influence of the identification and susceptibility testing method on the time to report results to the treating physicians.
