Clinical, Microbiological and Resistance Profile of Candidemia and Invasive Pulmonary Aspergillosis in Immunocompromised Patients and ICU Patients in Seven Colombian Hospitals

Background: Candidemia and invasive pulmonary aspergillosis (IPA) are major fungal infections in immunocompromised patients and patients admitted to the intensive care unit (ICU). Considering the few available data in Colombia, we carried out a nationwide study to determine the clinical, microbiological and resistance profile of patients with candidemia and IPA.

Methods: We conducted a multicenter observational study in seven tertiary healthcare settings from four Colombian cities between March 2015 and April 2016. All adult patients who were immunocompromised or admitted to the ICU with Candida bloodstream infection or Aspergillus pneumonia were included. For the final diagnosis, additionally to a compatible clinical syndrome, one blood culture was required for candidemia and one bronchoalveolar lavage fluid culture for IPA. Fungal identification and broth microdilution susceptibility testing were performed using CLSI breakpoints for MIC interpretation.

Results: A total of 71 patients were included; 64 patients had candidemia and 7 had IPA. The most common fungal species were C. albicans (27, 38%), C. tropicalis (14, 20%), C. parapsilosis (12, 17%), C. haemulonii (7, 10%) and A. fumigatus (5, 7%). Previous hospitalization was reported in 32 patients (45%). The median length of stay was 33 days (range 1-204). All patients had comorbidities, mainly infectious (36, 51%) and cardiovascular diseases (28, 39%). Empirical antibiotics were administered to 67 patients (94%). Antifungal therapy was given to 29 patients (41%) during 1 to 36 days; the most common antifungal given was caspofungin (18, 62%), followed by fluconazole (14, 48%). Among 26 C. albicans isolates with susceptibility data, 23 (89%), 14 (54%) and 25 (96%) were susceptible to fluconazole, itraconazole and voriconazole, respectively. All Candida spp. isolates were susceptible to posaconazole, amphotericin B, caspofungin and anidulafungin.

Conclusion: This study provides valuable information on the species distribution and susceptibility profile of Candida bloodstream infections in tertiary healthcare settings of Colombia, which is useful for an appropriate empirical antifungal therapy.