Sébastien Bailly1, Danièle Maubon2, Pierre Fournier3, Hervé Pelloux4, Carole Schwebel5, Claire Chapuis6, Luc Foroni7, Muriel Cornet8, Jean-François Timsit9. 1. U823, Grenoble Alpes University, Rond-point de la Chantourne, F-38700 La Tronche, France; Parasitology-Mycology Laboratory, Institut de Biologie et de Pathologie, CHU de Grenoble, Grenoble, France; UMR 1137 - IAME Team 5 - DeSCID: Decision SCiences in Infectious Diseases, Control and Care Inserm/Paris Diderot, Sorbonne Paris Cité University, 16 rue Henri Huchard, Paris F-75018, France. Electronic address: sbailly@chu-grenoble.fr. 2. Parasitology-Mycology Laboratory, Institut de Biologie et de Pathologie, CHU de Grenoble, Grenoble, France; TIMC-IMAG-TheREx, UMR 5525 CNRS-UJF, Grenoble Alpes University, La Tronche F-38700, France. Electronic address: dmaubon@chu-grenoble.fr. 3. Parasitology-Mycology Laboratory, Institut de Biologie et de Pathologie, CHU de Grenoble, Grenoble, France. Electronic address: Pierre.FOURNIER@biomnis.com. 4. Parasitology-Mycology Laboratory, Institut de Biologie et de Pathologie, CHU de Grenoble, Grenoble, France; UMR 5163 LAPM CNRS-UJF, Grenoble Alpes University, France. Electronic address: hpelloux@chu-grenoble.fr. 5. Medical ICU, Grenoble University Hospital, Boulevard de la Chantourne, F-38700 La Tronche, France. Electronic address: cschwebel@chu-grenoble.fr. 6. Pharmacy, Grenoble University Hospital, Boulevard de la Chantourne, F-38700 La Tronche, France. Electronic address: cchapuis1@chu-grenoble.fr. 7. Pharmacy, Grenoble University Hospital, Boulevard de la Chantourne, F-38700 La Tronche, France. Electronic address: lforoni@chu-grenoble.fr. 8. Parasitology-Mycology Laboratory, Institut de Biologie et de Pathologie, CHU de Grenoble, Grenoble, France; TIMC-IMAG-TheREx, UMR 5525 CNRS-UJF, Grenoble Alpes University, La Tronche F-38700, France. Electronic address: mcornet@chu-grenoble.fr. 9. UMR 1137 - IAME Team 5 - DeSCID: Decision SCiences in Infectious Diseases, Control and Care Inserm/Paris Diderot, Sorbonne Paris Cité University, 16 rue Henri Huchard, Paris F-75018, France; Medical and Infectious Diseases ICU, Paris Diderot University/Bichat Hospital, 46 rue Henri Huchard, Paris F-75018, France. Electronic address: jean-francois.timsit@bch.aphp.fr.
Abstract
INTRODUCTION: The incidence of Candida spp. infections is worrisome, particularly in critically ill patients. Previous reports suggested that increasing use of antifungal therapy might affect resistance profiles of invasive strains. The study objective was to describe the distribution resistance profile of Candida spp. strains, and to correlate it with antifungal consumptions within one ICU. METHOD: Antifungal drug consumption was measured as the number of defined daily doses per 1000 hospital days. The distribution of Candida spp. over a 10 year period 2004-2013 and the MICs of antifungal drugs over 2007-2013 were determined. Time series analyses were performed. RESULTS: Of 2403 identified Candida spp. from 5360 patients, Candida albicans predominated (53.1%), followed by Candida glabrata (16.2%), Candida parapsilosis (7.9%) and Candida tropicalis (7.5%). C. parapsilosis increased from 5.7% in 2004 to 8.4% in 2013 (P = 0.02). The increase in caspofungin use is correlated with the increase in caspofungin MICs of C. parapsilosis (P = 0.01), C. glabrata (P = 0.001) and C. albicans (P = 0.02). Polyenes consumption correlated with an increase in amphotericin B MICs of C. glabrata (P = 0.04). CONCLUSION: Previous history of antifungal prescription within an ICU influences Candida species distribution and susceptibility profile to antifungal agents. The significant selective pressure exerted by caspofungin and amphotericin B on C. glabrata is a concern.
INTRODUCTION: The incidence of Candida spp. infections is worrisome, particularly in critically illpatients. Previous reports suggested that increasing use of antifungal therapy might affect resistance profiles of invasive strains. The study objective was to describe the distribution resistance profile of Candida spp. strains, and to correlate it with antifungal consumptions within one ICU. METHOD: Antifungal drug consumption was measured as the number of defined daily doses per 1000 hospital days. The distribution of Candida spp. over a 10 year period 2004-2013 and the MICs of antifungal drugs over 2007-2013 were determined. Time series analyses were performed. RESULTS: Of 2403 identified Candida spp. from 5360 patients, Candida albicans predominated (53.1%), followed by Candida glabrata (16.2%), Candida parapsilosis (7.9%) and Candida tropicalis (7.5%). C. parapsilosis increased from 5.7% in 2004 to 8.4% in 2013 (P = 0.02). The increase in caspofungin use is correlated with the increase in caspofungin MICs of C. parapsilosis (P = 0.01), C. glabrata (P = 0.001) and C. albicans (P = 0.02). Polyenes consumption correlated with an increase in amphotericin B MICs of C. glabrata (P = 0.04). CONCLUSION: Previous history of antifungal prescription within an ICU influences Candida species distribution and susceptibility profile to antifungal agents. The significant selective pressure exerted by caspofungin and amphotericin B on C. glabrata is a concern.
Authors: Arsa Thammahong; Srisombat Puttikamonkul; John R Perfect; Richard G Brennan; Robert A Cramer Journal: Microbiol Mol Biol Rev Date: 2017-03-15 Impact factor: 11.056