Vol.70 No.1 January 2022

Identification of Candida species in cases of candidemia and drug susceptibility testing for appropriate antifungal therapy

Yuko Nagano¹⁾, Tetsuya Horino²⁾, Moeko Sato¹⁾, Miyako Yakabe¹⁾, Tomoko Hasegawa¹⁾, Midori Kono³⁾, Tomoyoshi Kaneko⁴⁾, Tomohiro Izumisawa⁴⁾ and Hiroshi Yoshida¹⁾

¹⁾Department of Laboratory Medicine, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, Japan
²⁾Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine
³⁾Department of Laboratory Medicine, The Jikei University School of Medicine
⁴⁾Department of Pharmacy, The Jikei University Kashiwa Hospital

Abstract

Candidemia is one of the critical bloodstream infections, since it is associated with a high mortality rate and could be complicated by fungal endophthalmitis. To evaluate the importance of tests for fungal identification and drug susceptibility testing for appropriate antifungal therapy in cases of candidemia, we conducted a retrospective cohort study at the Jikei University Kashiwa Hospital. This study included adult patients who had been diagnosed as having candidemia between April 2015 and March 2018. Of the 24 patients included in this study, 10 (41.7%) were men, and the median age was 73 years (range, 21-94 years). One patient with bloodstream infection caused by Candida albicans developed endophthalmitis, and the most common infection source was catheter-related bloodstream infection (17 of 24 cases [70.8%]). Of the 24 patients, 7 (29.2%) died within 30 days of the onset of candidemia, and in 5 patients, appropriate antifungal therapy was not instituted within 48 hours. In a comparison of the results of the identification tests employed, 3 strains of Candida sp. and 1 strain of Candida glabrata as identified by BD™ CHROMagar™ Candida medium were identified as Candida parapsilosis and Candida lusitaniae by mass spectrometry, respectively. In addition, antifungal susceptibility testing showed that 1 of 8 strains of C. albicans was resistant to azoles, and 1 of 3 strains of C. glabrata was resistant to micafungin. Our results demonstrated that identification of the Candida sp. and antifungal drug susceptibility testing are important for appropriate antifungal therapy in cases of candidemia.

Key word

candidemia, mass spectrometry, drug susceptibility test, identification, appropriate use

Received

July 1, 2021

Accepted

October 18, 2021

Jpn. J. Chemother. 70 (1): 80-87, 2022