Candida blood stream infections observed between 2011 and 2016 in a large Italian University Hospital: A time-based retrospective analysis on epidemiology, biofilm production, antifungal agents consumption and drug-susceptibility

Autoři: Grazia Brunetti aff001;  Anna Sara Navazio aff002;  Alessandro Giuliani aff003;  Alessandra Giordano aff001;  Enrica Maria Proli aff005;  Guido Antonelli aff002;  Giammarco Raponi aff001
Působiště autorů: Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy aff001;  Department of Molecular Medicine, Laboratory of Microbiology and Pasteur Institute-Cenci Bolognetti Foundation, Sapienza University of Rome, Rome, Italy aff002;  Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy aff003;  Microbiology and Virology Unit, Sapienza University Hospital Policlinico Umberto I, Rome, Italy aff004;  Hospital Pharmacy, University Hospital Policlinico Umberto I, Rome, Italy aff005
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224678


Candida bloodstream infection (BSI) represents a growing infective problem frequently associated to biofilm production due to the utilization of intravascular devices. Candida species distribution (n = 612 strains), their biofilm production and hospital antifungal drug consumption were evaluated in different wards of a tertiary care academic hospital in Italy during the years 2011–2016. In the considered time window, an increasing number of Candida BSI (p = 0.005) and of biofilm producing strains were observed (p<0.0001). Although C. albicans was the species more frequently isolated in BSI with a major biofilm production, an increased involvement of non-albicans species was reported, particularly of C. parapsilosis that displayed a high frequency in catheter infections, and lower biofilm production compared to C. albicans. Although trends of biofilm production were substantially stable in time, a decreasing biofilm production by C. parapsilosis in the Intensive Care Unit (ICU) was observed (p = 0.0041). Principal component analysis displayed a change in antifungal drugs consumption driven by two mutually independent temporal trends, i.e. voriconazole use in the general medicine wards initially, and fluconazole use mainly in the ICU; these factors explain 68.9% and 25.7% of total variance respectively. Moreover, a significant trend (p = 0.003) in fluconazole use during the whole time period considered emerged, particularly in the ICU (p = 0.017), but also in the general medicine wards (p = 0.03). These trends paralleled with significant increase MIC90 of fluconazole (p = 0.05), particularly for C. parapsilosis in the ICU (p = 0.04), with a general and significant decreased trend of the MIC90 values of caspofungin (p = 0.04), and with significant increased MIC50 values for amphotericin B (p = 0.01) over the study period. In conclusion, drug utilization in our hospital turned out to be a putative influencing factor on the ecology of the species, on the increase in time of the biofilm producing strains and on the Candida antifungal susceptibility profile, thus influencing clinical management.

Klíčová slova:

Antifungals – Antimicrobial resistance – Biofilms – Candida – Candida albicans – Catheters – Intensive care units – Amphotericin


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2019 Číslo 11