Emergence of azole-resistant Candida parapsilosis causing bloodstream infection: results from laboratory-based sentinel surveillance in South Africa.

Autor:	Govender NP; National Institute for Communicable Diseases-Centre for Opportunistic, Tropical and Hospital Infections, a Division of the National Health Laboratory Service, Johannesburg, South Africa Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa neleshg@nicd.ac.za., Patel J; National Institute for Communicable Diseases-Centre for Opportunistic, Tropical and Hospital Infections, a Division of the National Health Laboratory Service, Johannesburg, South Africa., Magobo RE; National Institute for Communicable Diseases-Centre for Opportunistic, Tropical and Hospital Infections, a Division of the National Health Laboratory Service, Johannesburg, South Africa Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa., Naicker S; National Institute for Communicable Diseases-Centre for Opportunistic, Tropical and Hospital Infections, a Division of the National Health Laboratory Service, Johannesburg, South Africa., Wadula J; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Chris Hani Baragwanath Hospital, National Health Laboratory Service, Johannesburg, South Africa., Whitelaw A; Tygerberg Hospital, National Health Laboratory Service and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa., Coovadia Y; Inkosi Albert Luthuli Hospital, National Health Laboratory Service and Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa., Kularatne R; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Helen Joseph Hospital, National Health Laboratory Service, Johannesburg, South Africa., Govind C; Lancet Laboratories, Durban, South Africa., Lockhart SR; Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA., Zietsman IL; Ampath National Laboratory Service, Johannesburg, South Africa.
Jazyk:	angličtina
Zdroj:	The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2016 Jul; Vol. 71 (7), pp. 1994-2004. Date of Electronic Publication: 2016 Apr 28.
DOI:	10.1093/jac/dkw091
Abstrakt:	Objectives: To compare Candida species distribution and antifungal susceptibility at South African public- and private-sector hospitals. Methods: From February 2009 through to August 2010, laboratory-based surveillance for candidaemia was undertaken at 11 public-sector hospitals and >85 private-sector hospitals across South Africa. A case was defined as a patient of any age admitted to a sentinel hospital with isolation of Candida species from blood culture. Viable isolates were identified and tested for antifungal susceptibility at a reference laboratory. Demographic and limited clinical data were abstracted from laboratory records. Results: In total, 2172 cases of candidaemia were detected. Among patients with available data, almost two-thirds were critically ill (719/1138, 63%). On multivariable analysis, neonates [adjusted OR (aOR), 2.2; 95% CI, 1.5-3.1; P < 0.001] and patients diagnosed in Gauteng province (aOR, 1.9; 95% CI, 1.3-2.7; P < 0.001) or in the private sector (aOR, 1.9; 95% CI, 1.2-3.2; P = 0.008) were significantly more likely to be infected with Candida parapsilosis than any other Candida species. Of 531 C. parapsilosis isolates, only 199 (37%) were susceptible to fluconazole and voriconazole; 44% (123/282) of fluconazole-resistant isolates were voriconazole cross-resistant. Factors associated with fluconazole non-susceptible C. parapsilosis infection on multivariable analysis included diagnosis in Gauteng province (aOR, 4.2; 95% CI, 2.7-6.7; P < 0.001), an ICU (aOR, 2.3; 95% CI, 1.5-3.6; P < 0.001) or the private sector (aOR, 2.2; 95% CI, 1.4-3.5; P < 0.001). Conclusions: The dominance of triazole non-susceptible C. parapsilosis limits the choice of antifungal agents for management of candidaemia among critically ill neonates, children and adults in resource-limited South African hospitals. (© The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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