Epidemiology and Risk Factors for Echinocandin Nonsusceptible Candida glabrata Bloodstream Infections: Data From a Large Multisite Population-Based Candidemia Surveillance Program, 2008–2014

Details

• Alternative Title:
  Open Forum Infect Dis
• Personal Author:
  Vallabhaneni, Snigdha ; Cleveland, Angela A. ; Farley, Monica M. ; Harrison, Lee H. ; Schaffner, William ; Beldavs, Zintar G. ; Derado, Gordana ; Pham, Cau D. ; Lockhart, Shawn R. ; Smith, Rachel M.
• Description:
  Background.  Echinocandins are first-line treatment for Candida glabrata candidemia. Echinocandin resistance is concerning due to limited remaining treatment options. We used data from a multisite, population-based surveillance program to describe the epidemiology and risk factors for echinocandin nonsusceptible (NS) C glabrata candidemia. Methods.  The Centers for Disease Control and Prevention's Emerging Infections Program conducts population-based laboratory surveillance for candidemia in 4 metropolitan areas (7.9 million persons; 80 hospitals). We identified C glabrata cases occurring during 2008-2014; medical records of cases were reviewed, and C glabrata isolates underwent broth microdilution antifungal susceptibility testing. We defined echinocandin-NS C glabrata (intermediate or resistant) based on 2012 Clinical and Laboratory Standards Institute minimum inhibitory concentration breakpoints. Independent risk factors for NS C glabrata were determined by stepwise logistic regression. Results.  Of 1385 C glabrata cases, 83 (6.0%) had NS isolates (19 intermediate and 64 resistant); the proportion of NS isolates rose from 4.2% in 2008 to 7.8% in 2014 (P < .001). The proportion of NS isolates at each hospital ranged from 0% to 25.8%; 3 large, academic hospitals accounted for almost half of all NS isolates. In multivariate analysis, prior echinocandin exposure (adjusted odds ratio [aOR], 5.3; 95% CI, 2.6-1.2), previous candidemia episode (aOR, 2.5; 95% CI, 1.2-5.1), hospitalization in the last 90 days (aOR, 1.9; 95% CI, 1.0-3.5, and fluconazole resistance [aOR, 3.6; 95% CI, 2.0-6.4]) were significantly associated with NS C glabrata. Fifty-nine percent of NS C glabrata cases had no known prior echinocandin exposure. Conclusion.  The proportion of NS C glabrata isolates rose significantly during 2008-2014, and NS C glabrata frequency differed across hospitals. In addition to acquired resistance resulting from prior drug exposure, occurrence of NS C glabrata without prior echinocandin exposure suggests possible transmission of resistant organisms.
• Subjects:
  Candida Glabrata Candidemia Echinocandin Resistance Epidemiology Major Articles Risk Factors Transmission Of Drug Resistance
• Source:
  Open Forum Infect Dis. 2015; 2(4).
• Pubmed ID:
  26677456
• Pubmed Central ID:
  PMC4677623
• Document Type:
  Journal Article
• Volume:
  2
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:6526721bfc4065a121f4614f0ceb2e32a11ef2741470b53196f6e1f65737d79a
• Download URL:
  https://stacks.cdc.gov/view/cdc/36948/cdc_36948_DS1.pdf
• File Type:
  [PDF - 194.89 KB ]