637. Candida Bloodstream Infection (CBI): Comparison of Species Distribution and Resistance to Micafungin (MCF) and Azole Antifungal Agents in Intensive Care Unit (ICU) and Non-ICU Settings
Session: Abstracts: Mycology
Friday, October 22, 2010
Background: 30-50% of CBI occur in the ICU. However, most data on species distribution and antifungal resistance (R) in ICUs are limited to single medical centers, and do not compare species distribution and MCF or azole R profile to those from non-ICU environments.

Methods: We analyzed CLSI MIC data from the SENTRY Antimicrobial Surveillance Program (2008-2009) to compare the antifungal-R profiles and species of CBI isolates obtained from patients in ICU vs non-ICU locations in 79 medical centers. MIC results were obtained for MCF, fluconazole (FLC), posaconazole (PSC) and voriconazole (VRC) after 24-hours incubation. Recently revised CLSI breakpoints for R were employed: MCF MICs >0.5 µg/ml were R for C. albicans (Ca), C. glabrata (Cg), C. tropicalis (Ct) and C. krusei (Ck); MICs >4 µg/ml were R for C. parapsilosis (Cp); FLC MICs >4 µg/ml were R for Ca, Cp and Ct; MICs >32 µg/ml were R for Cg; and PSC and VRC MICs >2 µg/ml were considered R for all species.

Results: 1,752 Candida spp. were obtained from ICU (779) and non-ICU (973). 96% of the isolates in both settings were identified as Ca, Cg, Cp, Ct and Ck. The highest proportions of CBI due to Ca (50.4 vs. 47.4%) and Ct (10.5 vs 9.6%) were detected in the ICU and the highest proportions of Cg (18.1 vs 12.5%) and Cp (18.9 vs 15.1%) were seen in the non-ICU settings. There were no MCF-R strains of Cp, Ct or Ck in either setting; however MICs >0.5 µg/ml were found in 0.3% of Ca isolates, 0.7% of Cg from the ICU and in 1.2% of non-ICU isolates of Cg. Among Cg isolates from the ICU, 7.4% were R to PSC and 5.0% were R to VRC, where only 0.6 and 1.1% of non-ICU Cg isolates were R to PSC and VRC, respectively. Ct isolates from the ICU were more R to FLC (6.1 vs 2.2%) and VRC (4.9 vs 1.1%) than non-ICU CBI isolates.

Conclusion: Differences in both species distribution and antifungal R were detected between ICU and non-ICU hospital settings. ICU isolates of Cg and Ct were clearly more R to the azoles when compared to non-ICU isolates. MCF R was very uncommon in both treatment environments.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Michael A. Pfaller, M.D. , Microbiology, JMI Laboratories, North Liberty, IA
Gary J. Moet , Microbiology, JMI Laboratories, North Liberty, IA
Shawn A. Messer , Microbiology, JMI Laboratories, North Liberty, IA
Ronald Jones, MD , Microbiology, JMI Laboratories, North Liberty, IA

Disclosures:

M. A. Pfaller, Yes
Astellas : Consultant, Grant Investigator, Scientific Advisor and Speaker's Bureau, Consulting fee, Research grant and Speaker honorarium
Merck: Consultant, Grant Investigator, Scientific Advisor and Speaker's Bureau, Consulting fee, Research grant and Speaker honorarium
Pfizer: Consultant, Grant Investigator, Scientific Advisor and Speaker's Bureau, Consulting fee, Research grant and Speaker honorarium
Schering-Plough: Consultant, Grant Investigator, Scientific Advisor and Speaker's Bureau, Consulting fee, Research grant and Speaker honorarium

G. J. Moet, None

S. A. Messer, None

R. Jones, None

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