Candida orthopsilosis fungemias in a Spanish tertiary care hospital: Incidence, epidemiology and antifungal susceptibility / Fungemias por Candida orthopsilosis en un hospital terciario español: incidencia, epidemiología y sensibilidad a antifúngicos

Background. Few studies exist on prevalence of fungemia by Candida orthopsilosis, with variable results. Aims. To study the incidence, epidemiology and antifungal susceptibility of C. orthopsilosis strains isolated from fungemias over two years at a tertiary hospital. Methods. Candidemia episodes between June 2007 and June 2009 in a university hospital (Puerta del Mar, Cádiz, Spain) were studied. The strains initially identified as Candida parapsilosis were genotypically screened for C. parapsilosis sensu stricto, C. orthopsilosis and Candida metapsilosis, and their antifungal susceptibility was evaluated. Results. In this period 52 cases of candidemia were documented. Of the 19 strains originally identified as C. parapsilosis, 13 were confirmed as C. parapsilosis sensu stricto and 6 as C. orthopsilosis. Of the 52 isolates, the most frequent species were Candida albicans (30.8%), C. parapsilosis sensu stricto (25%), C. orthopsilosis, Candida tropicalis and Candida glabrata in equal numbers (11.5%). C. orthopsilosis isolates were susceptible to amphotericin B, caspofungin, voriconazole and fluconazole, with no significant differences in MIC values with C. parapsilosis sensu stricto. The source of isolates of C. orthopsilosis were neonates (50%) and surgery (50%), and 100% were receiving parenteral nutrition; however C. parapsilosis sensu stricto was recovered primarily from patients over 50 years (69.2%) and 46.1% were receiving parenteral nutrition. Conclusions. These findings show that C. orthopsilosis should be considered as human pathogenic yeast and therefore its accurate identification is important. Despite our small sample size our study suggests that a displacement of some epidemiological characteristics previously attributed to C. parapsilosis to C. orthopsilosis may be possible (AU)

Antecedentes. Apenas se han publicado estudios sobre la prevalencia de los episodios de fungemia por Candida orthopsilosis, y sus resultados han sido variables. Objetivos. Examinar la incidencia, epidemiología y sensibilidad a antifúngicos de las cepas de C. orthopsilosis aisladas de fungemias en un periodo de 2 años en un hospital de asistencia terciaria. Métodos. Entre junio de 2007 y junio de 2009, en el Hospital Universitario Puerta del Mar (Cádiz, España) se estudiaron todos los episodios de fungemia. Las cepas identificadas inicialmente como Candida parapsilosis se genotipificaron para su clasificación como C. parapsilosis sensu stricto, C. orthopsilosis y Candida metapsilosis, y se testó su sensibilidad a los antifúngicos. Resultados. Durante este periodo, se documentaron 52 episodios de fungemia. De las 19 cepas identificadas originalmente como C. parapsilosis, 13 fueron C. parapsilosis sensu stricto, y 6 C. orthopsilosis. De los 52 aislamientos, las especies más frecuentes fueron Candida albicans (30,8%), C. parapsilosis sensu stricto (25%) y C. orthopsilosis (11,5%), y Candida tropicalis y Candida glabrata fueron aisladas en igual número. Todos los aislamientos de C. orthopsilosis fueron sensibles a anfotericina B, caspofungina, voriconazol y fluconazol, sin diferencias significativas en las concentraciones inhibitorias mínimas obtenidas con C. parapsilosis sensu stricto. Los aislamientos de C. orthopsilosis procedían de recién nacidos (50%) y de pacientes sometidos a cirugía (50%). El 100% de los pacientes recibía nutrición parenteral; sin embargo, el foco de C. parapsilosis sensu stricto procedía, ante todo, de pacientes de más de 50 años de edad (69,2%), y el 46,1% recibía nutrición parenteral. Conclusiones. Los resultados del presente estudio revelan que C. orthopsilosis debe considerarse una levadura patogénica para el ser humano y, por esta razón, es importante su identificación. A pesar del pequeño tamaño de la muestra, el presente estudio evidencia el desplazamiento a C. orthopsilosis de algunas características epidemiológicas atribuidas previamente a C. parapsilosis (AU)

Candida orthopsilosis fungemias in a Spanish tertiary care hospital: incidence, epidemiology and antifungal susceptibility.

BACKGROUND: Few studies exist on prevalence of fungemia by Candida orthopsilosis, with variable results. AIMS: To study the incidence, epidemiology and antifungal susceptibility of C. orthopsilosis strains isolated from fungemias over two years at a tertiary hospital. METHODS: Candidemia episodes between June 2007 and June 2009 in a university hospital (Puerta del Mar, Cádiz, Spain) were studied. The strains initially identified as Candida parapsilosis were genotypically screened for C. parapsilosis sensu stricto, C. orthopsilosis and Candida metapsilosis, and their antifungal susceptibility was evaluated. RESULTS: In this period 52 cases of candidemia were documented. Of the 19 strains originally identified as C. parapsilosis, 13 were confirmed as C. parapsilosis sensu stricto and 6 as C. orthopsilosis. Of the 52 isolates, the most frequent species were Candida albicans (30.8%), C. parapsilosis sensu stricto (25%), C. orthopsilosis, Candida tropicalis and Candida glabrata in equal numbers (11.5%). C. orthopsilosis isolates were susceptible to amphotericin B, caspofungin, voriconazole and fluconazole, with no significant differences in MIC values with C. parapsilosis sensu stricto. The source of isolates of C. orthopsilosis were neonates (50%) and surgery (50%), and 100% were receiving parenteral nutrition; however C. parapsilosis sensu stricto was recovered primarily from patients over 50 years (69.2%) and 46.1% were receiving parenteral nutrition. CONCLUSIONS: These findings show that C. orthopsilosis should be considered as human pathogenic yeast and therefore its accurate identification is important. Despite our small sample size our study suggests that a displacement of some epidemiological characteristics previously attributed to C. parapsilosis to C. orthopsilosis may be possible.