Epidemiology, Diagnosis, and Therapy of Fungal Infections in Surgery

Use of amplified fragment length polymorphism analysis to identify medically important Candida spp., including C. dubliniensis

Non-Candida albicans Candida species are increasingly being isolated. These species show differences in levels of resistance to antimycotic agents and mortality. Therefore, it is important to be able to correctly identify the causative organism to the species level. Identification of C. dubliniensis in particular remains problematic due to the high degree of phenotypic similarity between this species and C. albicans. The use of amplified fragment length polymorphism (AFLP) analysis as an identification method for medically important Candida species was investigated. Our results show very clear differences among medically important Candida species. Furthermore, when screening a large collection of clinical isolates previously identified on CHROMagar as C. albicans, we found a misidentification rate of 6%. AFLP analysis is universally applicable, and the patterns can easily be stored in a general, accessible database. Therefore, AFLP might prove to be a reliable method for the identification of medically important Candida species.

Candidemia at a University Hospital: epidemiology, risk factors and predictors of mortality

BACKGROUND

Blood stream infection due to candida species are becoming increasingly important causes of morbidity and mortality in hospitalized patients. The aim of this study was to obtain epidemiological data on candidemia in patients at King Abdulaziz University Hospital (KAUH), and to discuss the influence of several clinical variables on the development and outcome of candidemia.

MATERIALS AND METHODS

Demographic information, risk factors, therapy and outcome of all patients who had candidemia at KAUH between January 1998 and December 1999 were reviewed.

RESULTS

Thirty-one candidemic episodes were identified. All the candidemic episodes were hospital acquired. The most common risk factors to candidemia were central venous catheters (87%), stay in intensive care unit (ICU) (77%), and broad-spectrum antibiotics therapy (74%). Candida albicans was the most frequently isolated species (71%), followed by candida tropicalis and candida parapsilosis (13% each). Twenty-six patients (84%) were treated with amphotericin B, 4 (13%) with fluconazole, and one (3%) with ketoconazole. Antifungal susceptibility testing of the isolates in general revealed minimal levels of resistance to amphotericin B (3%) versus 39% resistance to fluconazole. Less than 5% of Candida albicans were resistant to amphotericin B, in comparison with >35% of these strains that were resistant to fluconazole. The overall mortality was 71%. Mortality was significantly associated with the presence of central venous catheters (P=0.001), stay in intensive care unit (P<0.001), and prolonged hospital stay before the onset of candidemia (P=0.05).

CONCLUSION

Despite antifungal treatment, the mortality of candidemia is still high. Rapid changes in the rate of infection, potential risk factors, and emerging species demand continued and close surveillance of this serious infection.