635. Species Distribution and Frequency of Antifungal Resistance (R) Variations Among Candida Bloodstream Infections (BSI) Isolates by Patient Age: Report From the SENTRY Program
Session: Abstracts: Mycology
Friday, October 22, 2010
Background: Variations in Candida species causing BSI and frequency of R to fluconazole (FLC) by patient age has been described before. Similar data however, is not known for echinocandins, such as anidulafungin (ANF), caspofungin (CSF), and micafungin (MCF) nor the newer azoles, (posaconazole [PSC] and voriconazole [VRC]).

Methods: We analyzed 24-h CLSI MICs from the SENTRY Program to compare antifungal profiles and species distribution of Candida BSI isolates by patient age. MIC results were obtained for 6 antifungal agents and revised CLSI breakpoints were used to identify R strains: ANF, CSF, and 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 R for all species.

Results: 1,239 Candidemia isolates were obtained from 79 hospitals (five countries) in 2008-2009: 50.0% were Ca, 17.9% were Cg, 17.4% were Cp, 9.8% were Ct and 1.8% were Ck. Ca was most common in 60-79 yr age group (52.3%) and least common in 80-99 yr age group (46.7%), whereas Cg was most common in 80-99 yr age group (28.6%). Cp and Ct occurred most often in 0-19 yr age group (28.5 and 12.9%, respectively), and Ck was most common in 20-39 yr age group (3.5%). No R to echinocandins was detected among Ca, Cp, and Ct in all age groups. Likewise, no R to PSC or VRC was observed among Ca, Cp or Ck isolates. R to azoles and echinocandins was most prominent in Cg with the highest R rates to ANF (16.7%), CSF (16.7), MCF (11.1), FLC (16.7), and PSC (5.6) found in isolates from 20-29 yr age group. No R (any drug) was detected in Cg isolates from the youngest (0-19 yr) and oldest (80-99 yr) age groups.

Conclusion: Both species distribution and antifungal R patterns varied widely with patient age. Cg BSI isolates may show R to both azoles and echinocandins, with the highest rates of refractory isolates observed in patients aged 20-30 yr followed by the 40-59 yr age group.


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

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

R. Jones, None

S. A. Messer, None

G. J. Moet, None

See more of: Mycology
See more of: Abstracts

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 21 with the exception of research findings presented at IDSA press conferences.

 
 
   
 

Copyright IDSA 2009 Infectious Diseases Society of America 1300 Wilson Boulevard, Suite 300 Arlington, VA 22209 info@idsociety.org