892. Emergence of Hospital-Wide Triazole Resistant Candida glabrata Bloodstream Infections
Session: Poster Abstract Session: Antifungal Therapy
Saturday, October 22, 2011
Room: Poster Hall B1
Background: 

The rise of Candida glabrata bloodstream infections (BSIs) over the past decade has been associated with increased use of broad spectrum antifungal prophylaxis and treatment, especially in patients with hematological malignancies and in hematopoietic stem cell transplant (HSCT) recipients.  Based on a perceived increase in C. glabrata BSIs at our institution, we performed a retrospective analysis of Candida species BSI distribution over the past 9 years.  Antifungal resistance profiles of C. glabrata BSIs were also examined.

Methods: 

Candida spp. recovered from blood from 2001 to 2010 were studied.  Repeat isolates from patients were excluded.  Susceptibility testing of the 2010 C. glabrata isolates was performed using YeastOne (TREK Diagnostics Systems, Cleveland, OH).  Prior to 2010, susceptibility testing of isolates was performed either by YeastOne or by CLSI standard broth microdilution or disk diffusion methodology.

Results: 

With a relatively constant annual rate of candidemia per year, the total number of C. glabrata BSIs increased from a median of 5 positive patients annually (from 2001 to 2009) to 20 positive patients in 2010 (18% of all isolates in 2001-2009; 36% of all isolates in 2010).  Five (25%) of 20 patients with C. glabrata BSI during 2010 were located on the hematology (HEM) and HSCT services, where antifungal triazole prophylaxis is widely used.  By 2010, 9/20 (45%) isolates were either susceptible dose dependent (SDD) or resistant (R) to fluconazole (F); 5 were resistant to F.  6/9 F-SDD or -R isolates were from units other than HEM and HSCT.  Of the 7 patients with C. glabrata BSIs from intensive care units (cardiac, surgical and medical), 4 were F-SDD or -R.  Isolates for which posaconazole (P) minimum inhibitory concentrations (MICs) were ≥2 µg/mL were recovered from 5 patients, only two of whom were hospitalized on the HEM and HSCT units.   

Conclusion: 

There has been a progressive increase in the percent of candidemia caused by C. glabrata at our institution over the past 9 years.  F- and P-resistant C. glabrata BSIs emerged in patients from multiple hospital locations.  Triazole-resistant C. glabrata BSIs may emerge simultaneously in multiple areas of the hospital, including units where antifungal prophylaxis is not routinely used.


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

Audrey N. Schuetz, MD, MPH1, Flonza Isovski, MD2, Rosemary Soave, MD3, David Helfgott, MD3, David P. Calfee, MD4, Stephen J. Wilson, MD, MPH4, Tsiporah Shore, MD5, Eric Feldman, MD6, Stephen Jenkins, PhD7 and Thomas Walsh, MD, FIDSA8, (1)Pathology and Laboratory Medicine, Weill Cornell Medical Center/ NewYork-Presbyterian Hospital, New York, NY, (2)Medicine, NewYork-Presbyterian Hospital, New York, NY, (3)Medicine/Infectious Diseases, Transplantation-Oncology, Weill Cornell Medical Center/ NewYork-Presbyterian Hospital, New York, NY, (4)Medicine/Infectious Diseases, Weill Cornell Medical Center/ NewYork-Presbyterian Hospital, New York, NY, (5)Stem Cell Transplantation Unit, Weill Cornell Medical Center/ NewYork-Presbyterian Hospital, New York, NY, (6)Hematology, Weill Cornell Medical Center/ NewYork-Presbyterian Hospital, New York, NY, (7)Weill Cornell Medical Center/ NewYork-Presbyterian Hospital, New York, NY, (8)Transplantation-Oncology, Weill Cornell Medical College of Cornell University, New York City, NY

Disclosures:

A. N. Schuetz, None

F. Isovski, None

R. Soave, None

D. Helfgott, Merck: Investigator, None

D. P. Calfee, None

S. J. Wilson, None

T. Shore, None

E. Feldman, None

S. Jenkins, Pfizer: Scientific Advisor, Consulting fee
Forest : Scientific Advisor, Consulting fee
Bayer: Scientific Advisor, Consulting fee

T. Walsh, None

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