Candidemia: species involved, virulence factors and antimycotic susceptibility

We investigate the characteristics of the Candida species involved in BSI episodes in our Institute, their phospholipase and protease activity and the susceptibility pattern towards the main antifungal agents currently available. From January 2009 to December 2010 we documented a total of 59 episodes of candidemia. The incidence of candidemia was 32% in General Surgery 22% in the Intensive Care Unit (ICU), 13% in Oncology and 10% in Gastroenterology C. albicans was the most common species (32 cases=48%), followed by C. glabrata (17 cases=26%) and C. parapsilosis (12 cases=18%), a significant production of phospholipase in all strains of C. albicans was detected. Among Candida non-albicans species, the production of this enzyme only occurred in 1/12 strains of C. parapsilosis. The expression of acid protease production was detected in 48% of C. albicans and no strains of Candida non-albicans. All species of Candida were susceptible to amphotericin B. The rate of susceptibility to fluconazole was 100% for C. albicans and C. parapsilosis. Decreased susceptibility to fluconazole was mostly seen with C. glabrata, which was 76.5% susceptible in a dose-dependent manner. The echinocandins showed a good performance for C. albicans, and maintained a good MIC distribution in C. glabrata.