1430. Candidemia Surveillance in Iowa
Session: Poster Abstract Session: Fungal Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • Matsumoto_IDWeek2013.png (454.6 kB)
  • Background: Bloodstream infections due to Candida cause significant morbidity and mortality. Surveillance for candidemia is necessary to help inform prevention efforts and empiric therapy decisions. We describe the recent epidemiology of candidemia in Iowa.

    Methods: We performed prospective surveillance for candidemia at 14 Iowa hospitals from January 2011-September 2012. Participating sites submitted all unique patient bloodstream isolates of Candida, along with patients’ clinical information. We performed testing to identify Candida species distribution, antifungal susceptibility, and existence of gene mutations associated with echinocandin resistance.

    Results: A total of 167 unique Candida bloodstream infection isolates were submitted.  The age range of patients was 0-94 years (median, 57 y), and 54% were female.  Sixty one (37%) patients were in ICU, and crude mortality was 21%.  C. albicans (n = 72 [43%]) and C. glabrata (n = 59 [35%]) were the most common species.  Crude mortality was lower for C. parapsilosis than for the other species (0% vs. 17-24%, respectively). In vitro susceptibility testing revealed antifungal resistance to be uncommon, with 94% of isolates susceptible to fluconazole and 96-99% susceptible to echinocandins.  Using new CLSI breakpoints, 8% of C. glabrata isolates were fluconazole resistant and 4% (2 isolates) were intermediate or resistant to one or more of echinocandins.  Molecular analyses of the fks1 and fks2 hotspot regions of all the C. glabrata revealed no mutations except in these two isolates (L628R and S629P in fks1). Compared with previous surveillance in 1998-2001, there was a substantial decrease in proportion of candidemia due to C. albicans (from 58 to 43%), and a commensurate increase in proportion due to C. glabrata (from 20 to 35%).  There were no major shifts in azole susceptibility between the two time periods.  

    Conclusion: The epidemiology of candidemia is changing in Iowa. We found a reduction in proportion of candidemia due to C. albicans, and an increase in disease due to C. glabrata, of which 4% had elevated echinocandin MICs and demonstrated mutations that could confer reduced echinocandin susceptibility. Further emergence of echinocandin resistance among C. glabrata would be problematic.

    Eiyu Matsumoto, MB1, Shailesh Tendolkar1, Jennifer Mcdanel, MS1, Linda Boyken1, Michael Pfaller, MD2 and Daniel J. Diekema, MD, FIDSA, FSHEA1, (1)University of Iowa, Carver College of Medicine, Iowa City, IA, (2)Jmi Laboratories, Inc., North Liberty, IA


    E. Matsumoto, None

    S. Tendolkar, None

    J. Mcdanel, None

    L. Boyken, None

    M. Pfaller, Schering: Grant Investigator, Grant recipient
    Pfizer: Grant Investigator, Grant recipient
    Merck: Grant Investigator, Grant recipient

    D. J. Diekema, Pfizer: Grant Investigator, Grant recipient
    Merck: Grant Investigator, Grant recipient
    Schering: Grant Investigator, Grant recipient

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