Prospective Study of Candida Species in Patients at a Comprehensive Cancer Center

doi:10.1128/AAC.45.7.2129-2133.2001

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Antimicrobial Agents and Chemotherapy, July 2001, p. 2129-2133, Vol. 45, No. 7
0066-4804/01/$04.00+0 DOI: 10.1128/AAC.45.7.2129-2133.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Prospective Study of Candida Species in Patients at a Comprehensive Cancer Center

Amar Safdar,¹^, Vishnu Chaturvedi,² Emily W. Cross,³ Steven Park,³ Edward M. Bernard,¹ Donald Armstrong,¹ and David S. Perlin³^,^*

Infectious Diseases Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center and Department of Medicine, Weill Medical College of Cornell University,¹ and The Public Health Research Institute,³ New York, and Mycology Laboratory, Axelrod Institute, New York State Department of Health, Albany,² New York

Received 24 July 2000/Returned for modification 20 January 2001/Accepted 11 April 2001

Since most nosocomial systemic yeast infections arise from the endogenous flora of the patient, we prospectively evaluatedthe species stratification and antifungal susceptibility profileof Candida spp. associated with heavy colonization and systemicinfection in patients at Memorial Sloan-Kettering Cancer Centerin New York. A total of 349 Candida isolates were obtained from223 patients during the later half of 1998. Cancer was the mostcommon underlying disease, occurring in 91% of the patients, including61.8% with organ and 23.7% with hematological malignancies; 4.4%of the patients had AIDS. Candida albicans was the predominantspecies (67.3%); among 114 non-albicans Candida spp., C. glabrata(45.6%) was the most frequent, followed by C. tropicalis (18.4%),C. parapsilosis (16.6%), and C. krusei (9.6%). The overall resistanceto triazole-based agents among all yeast isolates was 9.4 and10.8% for fluconazole and itraconazole, respectively. A totalof 5% of C. albicans strains were resistant to triazole antifungals,whereas 30.8 and 46.2% of C. glabrata strains were resistant tofluconazole (MIC $>=$ 64 µg/ml) and itraconazole (MIC $>=$ 1 µg/ml),respectively. A significant association was observed between priortreatment with triazole and isolation of fluconazole-resistantC. albicans (P = 0.005, OR 36), although this relationship wasnot seen in C. glabrata isolates (P = 0.4). This study reinforcesthe importance of periodic, prospective surveillance of clinicalfungal isolates to determine appropriate prophylactic, empiric,and preemptive antifungal therapy for the highly susceptible patientpopulation.

^* Corresponding author. Mailing address: The Public Health Research Institute, 455 First Ave., New York, NY 10021. Phone: (212)578-0820. Fax: (212) 578-0804. E-mail: perlin{at}phri.nyu.edu.

Present address: Division of Infectious Diseases, Department of Medicine, University of South Carolina School of Medicine,Columbia, S.C.

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