Invasive Fungal Infection in Romania: Changing Incidence and Epidemiology During Six Years of Surveillance in a Tertiary Hospital
The present study aimed to evaluate the incidence of candidemia, the trend of species distribution and the antifungal susceptibility patterns of all invasive strains of Candida spp. isolated over a 6-year period in an Eastern European University hospital. A total number of 156 isolates were reidentified by MALDI-TOF and tested for susceptibility by SensititreTM YeastOne™. Isolates were assigned as non-susceptible or belonging to the wild type according to the new CLSI (2017, 2018) break points and epidemiological cut-off values. C. parapsilosis (37.82%) was the most frequently isolated yeast, followed by C. albicans (26.28%). The general tendency of the species distribution during the surveyed period shifted towards an increase in C. parapsilosis and C. lusitaniae isolates. Fluconazole resistance was present in 23.52% of C. glabrata, 5.08% of C. parapsilosis and in none of the C. albicans, C. tropicalis and C. lusitaniae isolates. Echinocandin resistance was present only in 1(5.88%) C. glabrata isolate. The study emphasises the importance of monitoring local epidemiologic data and antifungal susceptibility trends due to the diversity of affected patient groups in our hospital.
KeywordsCandida spp. Invasive fungal infection Antifungal Resistance Susceptibility
The authors thank Doina Bilca, M.D, and Izabella Szasz, M.D., as well as the Microbiology Department laboratory technicians who have assisted in preparing the culture media and the yeast strains for the antifungal sensitivity testing.
The present study was partially supported by the Doctoral School (IOSUD) and an Internal Research Grant project with number 15/23.12.2014 provided by the University of Medicine and Pharmacy of Tîrgu Mureş. Romania. MALDI-TOF identification of Candida spp. was kindly sponsored and performed by the Synevo Central Laboratory, Bucharest.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
The authors declare that the data/results of the manuscript do not constitute plagiarism and have not been published elsewhere.
- 2.Pfaller MA, Moet GJ, Messer SA, Jones RN, Castanheira M. Candida bloodstream infections: Comparison of species distributions and antifungal resistance patterns in community-onset and nosocomial isolates in the SENTRY Antimicrobial Surveillance Program, 2008–2009. Antimicrob Agents Chemother. 2011;55(2):561–6.CrossRefGoogle Scholar
- 3.Minea B, Nastasa V, Moraru RF, Kolecka A, Flonta MM, Marincu I, et al. Species distribution and susceptibility profile to fluconazole, voriconazole and MXP-4509 of 551 clinical yeast isolates from a Romanian multi-centre study. Eur J Clin Microbiol Infect Dis. 2015;34(2):367–83.CrossRefGoogle Scholar
- 4.Clinical and Laboratory Standards Institute. Performance Standards for Antifungal Susceptibility Testing of Yeasts. 1st ed. CLSI supplement M60. Wayne, PA: Clinical and Laboratory Standards Institute; 2017.Google Scholar
- 5.Clinical and Laboratory Standards Institute. Epidemiological Cutoff Values for Antifungal Susceptibility Testing. 2nd ed. CLSI supplement M59. Wayne, PA: Clincal and Laboratory Standards Institute; 2018.Google Scholar
- 6.Orasch C, Marchetti O, Garbino J, Schrenzel J, Zimmerli S, Mühlethaler K, et al. Candida species distribution and antifungal susceptibility testing according to European Committee on Antimicrobial Susceptibility Testing and new vs. old Clinical and Laboratory Standards Institute clinical breakpoints: a 6-year prospective candidaemia s. Clin Microbiol Infect. 2014;20(7):698–705.CrossRefGoogle Scholar
- 9.Caggiano G, Coretti C, Bartolomeo N, Lovero G, De Giglio O, Montagna MT. Candida bloodstream infections in Italy: changing epidemiology during 16 years of surveillance. Biomed Res Int. 2015;7(2015):256580.Google Scholar
- 10.Pfaller MA, Diekema DJ, Gibbs DL, Newell VA, Ellis D, Tullio V, et al. Results from the artemis disk global antifungal surveillance study, 1997 to 2007: a 10.5-year analysis of susceptibilities of candida species to fluconazole and voriconazole as determined by CLSI standardized disk diffusion. J Clin Microbiol. 2010;48(4):1366–77.CrossRefGoogle Scholar
- 13.Montagna MT, Lovero G, Coretti C, Martinelli D, De Giglio O, Iatta R, et al. Susceptibility to echinocandins of Candida spp. strains isolated in Italy assessed by European Committee for Antimicrobial Susceptibility Testing and Clinical Laboratory Standards Institute broth microdilution methods. BMC Microbiol. 2015;15(1):1–6.CrossRefGoogle Scholar