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. 2014 Jul 3;9(7):e101510.
doi: 10.1371/journal.pone.0101510. eCollection 2014.

Epidemiology and outcomes of invasive candidiasis due to non-albicans species of Candida in 2,496 patients: data from the Prospective Antifungal Therapy (PATH) registry 2004-2008

Michael A Pfaller  1 , David R Andes  2 , Daniel J Diekema  3 , David L Horn  4 , Annette C Reboli  5 , Coleman Rotstein  6 , Billy Franks  7 , Nkechi E Azie  7
Affiliations

Epidemiology and outcomes of invasive candidiasis due to non-albicans species of Candida in 2,496 patients: data from the Prospective Antifungal Therapy (PATH) registry 2004-2008

Michael A Pfaller et al. PLoS One. .

Abstract

This analysis describes the epidemiology and outcomes of invasive candidiasis caused by non-albicans species of Candida in patients enrolled in the Prospective Antifungal Therapy Alliance (PATH Alliance) registry from 2004 to 2008. A total of 2,496 patients with non-albicans species of Candida isolates were identified. The identified species were C. glabrata (46.4%), C. parapsilosis (24.7%), C. tropicalis (13.9%), C. krusei (5.5%), C. lusitaniae (1.6%), C. dubliniensis (1.5%) and C. guilliermondii (0.4%); 111 infections involved two or more species of Candida (4.4%). Non-albicans species accounted for more than 50% of all cases of invasive candidiasis in 15 of the 24 sites (62.5%) that contributed more than one case to the survey. Among solid organ transplant recipients, patients with non-transplant surgery, and patients with solid tumors, the most prevalent non-albicans species was C. glabrata at 63.7%, 48.0%, and 53.8%, respectively. In 1,883 patients receiving antifungal therapy on day 3, fluconazole (30.5%) and echinocandins (47.5%) were the most frequently administered monotherapies. Among the 15 reported species, 90-day survival was highest for patients infected with either C. parapsilosis (70.7%) or C. lusitaniae (74.5%) and lowest for patients infected with an unknown species (46.7%) or two or more species (53.2%). In conclusion, this study expands the current knowledge of the epidemiology and outcomes of invasive candidiasis caused by non-albicans species of Candida in North America. The variability in species distribution in these centers underscores the importance of local epidemiology in guiding the selection of antifungal therapy.

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Conflict of interest statement

Competing Interests: The authors have read the journal’s policy and declare the following conflicts: MAP has received grant support and sat on advisory boards for Astellas Pharma, Merck and Pfizer. He is a consultant for JMI laboratories. DRA has received grant support from Astellas Pharma and consultancy fees from Merck. He is also a member of the PLOS ONE editorial board. DJD has received grant support from Astellas. DLH is a principal of David Horn, LLC and CEO of a private company, Mid-Atlantic BioTherapeutics, Inc. He has received consultancy fees from Astellas Pharma. ACR has received grant support from Merck and T3 Biosystems. CR has received grant support and Honoraria from Astellas Pharma and Honoraria from Merck and Pfizer. BF and NEA are employees of Astellas Pharma. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. 90-day survival stratified by non-albicans Candida species.
See this image and copyright information in PMC

References

    1. Pfaller MA, Diekema DJ (2010) Epidemiology of invasive mycoses in North America. Crit Rev Microbiol 36: 1–53. - PubMed
    1. Pfaller MA, Diekema D (2012) The epidemiology of invasive candidiasis. In: Calderone RA, editor. Candida and candidiasis. 2 ed. Washington DC: ASM Press. 449–480.
    1. Pfaller MA, Messer SA, Hollis RJ, Boyken L, Tendolkar S, et al. (2009) Variation in susceptibility of bloodstream isolates of Candida glabrata to fluconazole according to patient age and geographic location in the United States in 2001 to 2007. J Clin Microbiol 47: 3185–3190. - PMC - PubMed
    1. Pfaller MA, Diekema DJ (2004) Rare and emerging opportunistic fungal pathogens: concern for resistance beyond Candida albicans and Aspergillus fumigatus . J Clin Microbiol 42: 4419–4431. - PMC - PubMed
    1. Pfaller MA, Diekema DJ (2007) Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microbiol Rev 20: 133–163. - PMC - PubMed

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