Analysis on clinical characteristics and drug resistance of Candida parapsilosis bloodstream infections in West China Hospital, China, from 2012 to 2015

Abstract

Objective of the study: Candida parapsilosis has emerged as an important cause of bloodstream infections (BSI) in the health care setting. We aimed to describe the clinical characteristics and drug resistance of C. parapsilosis BSI in West China Hospital of Sichuan University in China and provide the basis for prevention and treatment of this disease.

Patients: We retrospectively collected and analyzed patients presented in our hospital reported with C. parapsilosis BSI from January 2012 to January 2015.

Materials and methods: Data regarding age, gender, the department distribution, the potential clinical risk factors and the result of clinical treatment and prognosis were retrospectively evaluated. As to the antifungal drugs susceptibility testing, we used Etest method for determining the minimum inhibitory concentrations (MICs) of amphotericin B, fluconazole, voriconazole, caspofungin and flucytosine for all the clinical isolates of C. parapsilosis. Standard quality strains were used as the controls.

Results: Most of the patients with C. parapsilosis BSI were over 60-year-old (37.5%) or within 10years old (28.13%). Among patients, 78.13% came from an intensive care unit or had undergone surgery in the past several months. The major risk factors associated with an increased risk of infection included the use of broad-spectrum antibacterial drugs and deep vein indwelling. The overall mortality of patients with C. parapsilosis BSI was 31.25%. The drug sensitivity tests revealed that all isolates were sensitive to amphotericin B and flucytosine. Two and 1 isolates were found susceptible to fluconazole and voriconazole in a dose-dependent manner, respectively. Only 1 isolate was resistant to fluconazole. 4 isolates (12.5%) were medium sensitive to caspofungin, but no one showed drug resistance.

Conclusion: In summary, elders and newborns were more vulnerable to C. parapsilosis infections. C. parapsilosis was found frequently as pathogens leading to BSI in patients admitted to ICU and departments of surgery and often causing a high mortality rate. C. parapsilosis rarely showed drug resistance at present, so common antifungal drugs could be used for treatment. Recommendations for using of antifungal drugs focused on paying close attention to possible drug resistance trend.

Keywords: Bloodstream infections; Candida parapsilosis; Clinical characteristics; Drug resistance.