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

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

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antifungal Agents / pharmacology
  • Antifungal Agents / therapeutic use*
  • Candida / drug effects*
  • Candida / isolation & purification
  • Candidiasis, Invasive / drug therapy*
  • Candidiasis, Invasive / epidemiology
  • Candidiasis, Invasive / mortality
  • Child
  • Child, Preschool
  • Drug Therapy, Combination
  • Echinocandins / pharmacology
  • Echinocandins / therapeutic use
  • Female
  • Fluconazole / pharmacology
  • Fluconazole / therapeutic use
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Registries
  • Survival Rate
  • Treatment Outcome
  • Young Adult

Substances

  • Antifungal Agents
  • Echinocandins
  • Fluconazole