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. 2015 Nov;21(11):1942-50.
doi: 10.3201/eid2111.150404.

Uncommon Candida Species Fungemia among Cancer Patients, Houston, Texas, USA

Dong Sik Jung, Dimitrios Farmakiotis, Ying Jiang, Jeffrey J Tarrand, Dimitrios P Kontoyiannis

Uncommon Candida Species Fungemia among Cancer Patients, Houston, Texas, USA

Dong Sik Jung et al. Emerg Infect Dis. 2015 Nov.

Abstract

Many uncommon Candida species that cause bloodstream infections (BSIs) are not well-characterized. We investigated the epidemiology, antifungal use, susceptibility patterns, and factors associated with all-cause death among cancer patients in whom uncommon Candida spp. BSIs were diagnosed at a cancer treatment center during January 1998–September 2013. Of 1,395 Candida bloodstream isolates, 79 from 68 patients were uncommon Candida spp. The incidence density of uncommon Candida spp. BSIs and their proportion to all candidemia episodes substantively increased during the study period, and the rise was associated with increasing use of echinocandin antifungal drugs. Thirty-seven patients had breakthrough infections during therapy or prophylaxis with various systemic antifungal drugs for >7 consecutive days; 21 were receiving an echinocandin. C. kefyr (82%), and C. lusitaniae (21%) isolates frequently showed caspofungin MICs above the epidemiologic cutoff values. These findings support the need for institutional surveillance for uncommon Candida spp. among cancer patients.

Keywords: C. dublinensis; C. famata; C. guilliermondii; C. kefyr; C. lusitaniae; Candida; Houston; Texas; USA; antimicrobial drugs; cancer; candidemia; caspofungin; echinocandins; fungi; non-albicans.

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Figures

Figure 1
Figure 1
Increasing A) incidence density and B) proportion relative to all episodes of candidemia for bloodstream infections caused by uncommon Candida species at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA, January 1998–September 2013. A) p<0.0001 and B) p = 0.001 for trend analyses. C) Incidence density of fungemia caused by uncommon Candida spp. during 1998–2005 compared with 2006–2013. There was a significant increase for C. lusitaniae (p<0.0001) and C. kefyr (p<0.0001) and a trend for increase for C. famata infections (p=0.068). C. guilliermondii infections remained stable.
Figure 2
Figure 2
Increasing annual use of echinocandin antifungal drugs at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA, January 2001–September 2013. Spearman’s correlation coefficient r = 0.98, p<0.0001. DDD, defined daily doses.
See this image and copyright information in PMC

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