Invasive candidiasis is a serious nosocomial infection developing generally in patients at risk; it is characterized by a severe clinical course and high (10-49%) additive mortality. It develops predominantly in immunocompromised, especially cancer, patients and patients in intensive care units. The purpose of the study was to analyze the etiology of invasive candidiasis and in vitro activity of caspofungin and azoles for isolates of Candida fungi.
Isolates were obtained in hospital departments in Rostov-on-Don and Rostov region in 2013-2016. Candida fungi were identified using MALDI-TOF MS; interpretation was performed according to CLSI 2012, M27-S4 criteria. Sensitivity testing was performed using the Sensititre system (Trek Diagnostic Systems, England).
92 Candida isolates were obtained from blood culture: C. albicans - 31.5% (29) and non-albicans - 68.5% (63), including C. tropicalis 30.2% (19), C. parapsilosis 28.6% (18), C. glabrata 19.0% (12), C. krusei 15.9% (10) and C. guilliermondii 6.3% (4). Fungal-bacterial associations were found in 5 cases; such combinations worsened the patient’s condition and complicated the treatment. The table demonstrates comparative activities of caspofungin, fluconasole and voriconasole (susceptible – S, intermediate – I, resistant – R) in % to Candida spp.Table: 1785P
|Species||n||Caspofungin S/ I/ R (%)||Fluconazole S/ I/ R (%)||Voriconazole S/ I/ R (%)|
|C. albicans||29||100/ 0/ 0||82/ 3/ 15||90/ 6/ 4|
|C. parapsilosis||18||98/ 0/ 2||82/ 4/ 14||88/ 11/ 1|
|C. tropicalis||19||100/ 0/ 0||90/ 5/ 5||100/ 0/ 0|
|C. glabrata||12||95/ 5/ 0||86/ 9/ 5||N/A|
|C. krusei||10||83/ 4/ 13||N/A||100/ 0/ 0|
Candida non albicans prevailed among invasive candidiasis pathogens (68.5%), which could be associated with the use of azole antifungal agents for the prophylaxis and empirical therapy. Dominating isolates showed decreased activity to caspofungin and azoles. Acquired resistance to azoles was noted for C. parapsilosis and C. albicans. Special attention should be paid to C. glabrata characterized by high lethality and high resistance rates. The results demonstrate the advisability of microbiological monitoring of invasive candidiasis pathogens.
Clinical trial identification
Legal entity responsible for the study
Ministry of Health of the Russian Federation.
Has not received any funding.
All authors have declared no conflicts of interest.