Affiliation:
1. Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
2. Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
3. Emory University, Atlanta, Georgia, USA
4. Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Abstract
ABSTRACT
Between 2008 and 2011, population-based candidemia surveillance was conducted in Atlanta, GA, and Baltimore, MD. Surveillance had been previously performed in Atlanta in 1992 to 1993 and in Baltimore in 1998 to 2000, making this the first population-based candidemia surveillance conducted over multiple time points in the United States. From 2,675 identified cases of candidemia in the current surveillance, 2,329
Candida
isolates were collected.
Candida albicans
no longer comprised the majority of isolates but remained the most frequently isolated species (38%), followed by
Candida glabrata
(29%),
Candida parapsilosis
(17%), and
Candida tropicalis
(10%). The species distribution has changed over time; in both Atlanta and Baltimore the proportion of
C. albicans
isolates decreased, and the proportion of
C. glabrata
isolates increased, while the proportion of
C. parapsilosis
isolates increased in Baltimore only. There were 98 multispecies episodes, with
C. albicans
and
C. glabrata
the most frequently encountered combination. The new species-specific CLSI
Candida
MIC breakpoints were applied to these data. With the exception of
C. glabrata
(11.9% resistant), resistance to fluconazole was very low (2.3% of isolates for
C. albicans
, 6.2% for
C. tropicalis
, and 4.1% for
C. parapsilosis
). There was no change in the proportion of fluconazole resistance between surveillance periods. Overall echinocandin resistance was low (1% of isolates) but was higher for
C. glabrata
isolates, ranging from 2.1% isolates resistant to caspofungin in Baltimore to 3.1% isolates resistant to anidulafungin in Atlanta. Given the increase at both sites and the higher echinocandin resistance,
C. glabrata
should be closely monitored in future surveillance.
Publisher
American Society for Microbiology
Cited by
224 articles.
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