Nelesh P Govender1, Jaymati Patel2, Rindidzani E Magobo3, Serisha Naicker2, Jeannette Wadula4, Andrew Whitelaw5, Yacoob Coovadia6, Ranmini Kularatne7, Chetna Govind8, Shawn R Lockhart9, Inge L Zietsman10. 1. National Institute for Communicable Diseases-Centre for Opportunistic, Tropical and Hospital Infections, a Division of the National Health Laboratory Service, Johannesburg, South Africa Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa neleshg@nicd.ac.za. 2. National Institute for Communicable Diseases-Centre for Opportunistic, Tropical and Hospital Infections, a Division of the National Health Laboratory Service, Johannesburg, South Africa. 3. National Institute for Communicable Diseases-Centre for Opportunistic, Tropical and Hospital Infections, a Division of the National Health Laboratory Service, Johannesburg, South Africa Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 4. Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Chris Hani Baragwanath Hospital, National Health Laboratory Service, Johannesburg, South Africa. 5. Tygerberg Hospital, National Health Laboratory Service and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa. 6. Inkosi Albert Luthuli Hospital, National Health Laboratory Service and Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa. 7. Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Helen Joseph Hospital, National Health Laboratory Service, Johannesburg, South Africa. 8. Lancet Laboratories, Durban, South Africa. 9. Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA. 10. Ampath National Laboratory Service, Johannesburg, South Africa.
Abstract
OBJECTIVES: To compare Candida species distribution and antifungal susceptibility at South African public- and private-sector hospitals. METHODS: From February 2009 through to August 2010, laboratory-based surveillance for candidaemia was undertaken at 11 public-sector hospitals and >85 private-sector hospitals across South Africa. A case was defined as a patient of any age admitted to a sentinel hospital with isolation of Candida species from blood culture. Viable isolates were identified and tested for antifungal susceptibility at a reference laboratory. Demographic and limited clinical data were abstracted from laboratory records. RESULTS: In total, 2172 cases of candidaemia were detected. Among patients with available data, almost two-thirds were critically ill (719/1138, 63%). On multivariable analysis, neonates [adjusted OR (aOR), 2.2; 95% CI, 1.5-3.1; P < 0.001] and patients diagnosed in Gauteng province (aOR, 1.9; 95% CI, 1.3-2.7; P < 0.001) or in the private sector (aOR, 1.9; 95% CI, 1.2-3.2; P = 0.008) were significantly more likely to be infected with Candida parapsilosis than any other Candida species. Of 531 C. parapsilosis isolates, only 199 (37%) were susceptible to fluconazole and voriconazole; 44% (123/282) of fluconazole-resistant isolates were voriconazole cross-resistant. Factors associated with fluconazole non-susceptible C. parapsilosis infection on multivariable analysis included diagnosis in Gauteng province (aOR, 4.2; 95% CI, 2.7-6.7; P < 0.001), an ICU (aOR, 2.3; 95% CI, 1.5-3.6; P < 0.001) or the private sector (aOR, 2.2; 95% CI, 1.4-3.5; P < 0.001). CONCLUSIONS: The dominance of triazole non-susceptible C. parapsilosis limits the choice of antifungal agents for management of candidaemia among critically ill neonates, children and adults in resource-limited South African hospitals.
OBJECTIVES: To compare Candida species distribution and antifungal susceptibility at South African public- and private-sector hospitals. METHODS: From February 2009 through to August 2010, laboratory-based surveillance for candidaemia was undertaken at 11 public-sector hospitals and >85 private-sector hospitals across South Africa. A case was defined as a patient of any age admitted to a sentinel hospital with isolation of Candida species from blood culture. Viable isolates were identified and tested for antifungal susceptibility at a reference laboratory. Demographic and limited clinical data were abstracted from laboratory records. RESULTS: In total, 2172 cases of candidaemia were detected. Among patients with available data, almost two-thirds were critically ill (719/1138, 63%). On multivariable analysis, neonates [adjusted OR (aOR), 2.2; 95% CI, 1.5-3.1; P < 0.001] and patients diagnosed in Gauteng province (aOR, 1.9; 95% CI, 1.3-2.7; P < 0.001) or in the private sector (aOR, 1.9; 95% CI, 1.2-3.2; P = 0.008) were significantly more likely to be infected with Candida parapsilosis than any other Candida species. Of 531 C. parapsilosis isolates, only 199 (37%) were susceptible to fluconazole and voriconazole; 44% (123/282) of fluconazole-resistant isolates were voriconazole cross-resistant. Factors associated with fluconazole non-susceptible C. parapsilosis infection on multivariable analysis included diagnosis in Gauteng province (aOR, 4.2; 95% CI, 2.7-6.7; P < 0.001), an ICU (aOR, 2.3; 95% CI, 1.5-3.6; P < 0.001) or the private sector (aOR, 2.2; 95% CI, 1.4-3.5; P < 0.001). CONCLUSIONS: The dominance of triazole non-susceptible C. parapsilosis limits the choice of antifungal agents for management of candidaemia among critically ill neonates, children and adults in resource-limited South African hospitals.
Authors: Shawn R Lockhart; Kizee A Etienne; Snigdha Vallabhaneni; Joveria Farooqi; Anuradha Chowdhary; Nelesh P Govender; Arnaldo Lopes Colombo; Belinda Calvo; Christina A Cuomo; Christopher A Desjardins; Elizabeth L Berkow; Mariana Castanheira; Rindidzani E Magobo; Kauser Jabeen; Rana J Asghar; Jacques F Meis; Brendan Jackson; Tom Chiller; Anastasia P Litvintseva Journal: Clin Infect Dis Date: 2016-10-20 Impact factor: 9.079
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