Candida tropicalis bloodstream infection: Incidence, risk factors and outcome in a population-based surveillance

Mario Fernández-Ruiz, Mireia Puig-Asensio, Jesús Guinea, Benito Almirante, Belén Padilla, Manuel Almela, Ana Díaz-Martín, Jesús Rodríguez-Baño, Manuel Cuenca-Estrella, José María Aguado, Patricia Muñoz, José Ramón Paño Pardo, Julio García-Rodríguez, Carlos García Cerrada, Jesús Fortún, Pilar Martín, Elia Gómez, Pablo Ryan, Carolina Campelo, Ignacio de los Santos GilVentura Buendía, Beatriz Perez Gorricho, Mercedes Alonso, Francisca Sanz Sanz, Paloma Merino, Fernando González Romo, Miguel Gorgolas, Ignacio Gadea, Juan Emilio Losa, Alberto Delgado-Iribarren, Antonio Ramos, Yolanda Romero, Isabel Sánchez Romero, Oscar Zaragoza, Ana Isabel Suarez, Ana Loza, Ana Isabel Aller García, Estrella Martín-Mazuelos, Maite Ruiz Pérez de Pipaón, José Garnacho, Carlos Ortiz, Mónica Chávez, Fernando L. Maroto, Miguel Salavert, Javier Pemán, José Blanquer, David Navarro, Juan José Camarena, Rafael Zaragoza, Vicente Abril, Concepci ón Gimeno, Silvia Hernáez, Guillermo Ezpeleta, Elena Bereciartua, José L. Hernández Almaraz, Miguel Montejo, Rosa Ana Rivas, Rafael Ayarza, Ana Ma Planes, Isabel Ruiz Camps, José Mensa, Mercè Gurgui, Ferran Sánchez-Reus, Joaquin Martinez-Montauti, Montserrat Sierra, Juan Pablo Horcajada, Luisa Sorli, Julià Gómez, Amadeu Gené, Mireia Urrea, Maricela Valerio, Francesc Puchades, Alessandra Mularoni

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Abstract

© 2015 The British Infection Association. 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.
Original languageEnglish
Pages (from-to)385-394
JournalJournal of Infection
Volume71
Issue number3
DOIs
Publication statusPublished - 1 Jan 2015

Keywords

  • Candida tropicalis bloodstream infection
  • Epidemiology
  • Minimum inhibitory concentration
  • Outcome
  • Treatment

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    Fernández-Ruiz, M., Puig-Asensio, M., Guinea, J., Almirante, B., Padilla, B., Almela, M., Díaz-Martín, A., Rodríguez-Baño, J., Cuenca-Estrella, M., Aguado, J. M., Muñoz, P., Paño Pardo, J. R., García-Rodríguez, J., Cerrada, C. G., Fortún, J., Martín, P., Gómez, E., Ryan, P., Campelo, C., ... Mularoni, A. (2015). Candida tropicalis bloodstream infection: Incidence, risk factors and outcome in a population-based surveillance. Journal of Infection, 71(3), 385-394. https://doi.org/10.1016/j.jinf.2015.05.009