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

• Type of Material: Article
• Authors: Snigdha Vallabhaneni, Centers for Disease Control and Prevention; Angela A. Cleveland, Centers for Disease Control and Prevention; Monica Farley, Emory University; Lee H. Harrison, Johns Hopkins University; William Schaffner, Vanderbilt University; Zintar G. Beldavs, Oregon Health Authority; Gordana Derado, Centers for Disease Control and Prevention; Cau D. Pham, Centers for Disease Control and Prevention; Shawn R. Lockhart, Centers for Disease Control and Prevention; Rachel M. Smith, Centers for Disease Control and Prevention
• Language: English
• Date: 2015-12
• Publisher: Oxford University Press (OUP)
• Publication Version: Final Published Version
• Copyright Statement: This work is written by (a) US Government employee(s) and is in the public domain in the US.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/ofid/ofv163
• Title of Journal or Parent Work: Open Forum Infectious Diseases
• ISSN: 2328-8957
• Volume: 2
• Issue: 4
• Start Page: ofv163
• End Page: ofv163
• Keywords: Candida glabrata; transmission of drug resistance; risk factors; Candidemia; echinocandin resistance; epidemiology
• Research Categories: Health Sciences, Pharmacology; Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

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.