Epidemiology and Antifungal Susceptibility in Patients
with Candidemia in a University Hospital, Thailand
Chotika Naranong, MD¹, Siriluck Anunnatsiri, MD¹, Sukanya Srigulbutr, MSc²
Affiliation : ¹ Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand ² Clinical Microbiology Laboratory Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background: Candidemia is the most common nosocomial invasive fungal infection that causes high mortality. Emergence of
drug-resistant Candida is reported worldwide but there are few studies in Thailand.
Objective: To determine the epidemiology, antifungal susceptibility of Candida , and outcomes among adult patients with candidemia.
Materials and Methods: A prospective, observational study in adult patients with candidemia was conducted in 2015 at a university hospital. Demographic, microbiological, and outcome data were recorded.
Results: Fifty-two patients with candidemia were identified, of whom 76.9% had an underlying disease and 69.2% had risks for candidemia. Sixty-four percent of candidemia patients contracted non- albicans Candida and 36% had Candida albicans . C. tropicalis was the most common non- albicans Candida species isolated (35%), followed by C. parapsilosis (19%), and C. glabrata (10%). Fluconazole resistance was found in 12.5% of C. albicans and in 11.1% of C. parapsilosis isolates. Reduced fluconazole susceptibility or high-level fluconazole resistance was found in 68.7% of C. tropicalis isolates. All except C. parapsilosis had excellent susceptibility to echinocandins. Seventy-three percent (38/52) of patients received antifungal treatment, of whom, 78.9% received empiric fluconazole therapy, and 89.7% were started on antifungal treatment 24 hours after the isolation of Candida . The overall mortality rate was 51.9%.
Conclusion: Fluconazole-resistant Candida became more prevalent particularly in C. tropicalis , which was the predominant species among non- albicans Candida causing candidemia. Empiric treatment with either amphotericin B or echinocandins would be appropriate in high-risk patients with suspected candidemia. Trial registration : Thai Clinical Trials Registry, TCTR20150605001
Received 28 October 2019 | Revised 23 December 2019 | Accepted 26 December 2019
doi.org/10.35755/jmedassocthai.2020.10.10822
Keywords : Candida , Fluconazole, Resistant, Thailand
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