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Diagn Microbiol Infect Dis. 2014 Jun;79(2):205-8. doi: 10.1016/j.diagmicrobio.2014.02.016. Epub 2014 Mar 1.

Candidemia surveillance in Iowa: emergence of echinocandin resistance.

Author information

1
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52246.
2
Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52246.
3
JMI Laboratories, North Liberty, IA.
4
Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52246; JMI Laboratories, North Liberty, IA.
5
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52246; Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA 52246. Electronic address: daniel-diekema@uiowa.edu.

Abstract

We performed prospective surveillance for candidemia at 14 Iowa hospitals in 2011-2012. A total of 163 episodes were analyzed. Candida albicans (n = 69 [42%]) and Candida glabrata (n = 58 [36%]) were the most common species. Antifungal resistance was uncommon; 9% of C. glabrata were fluconazole resistant, and 5% (3 isolates) were intermediate or resistant to 1 or more of the echinocandins. Molecular analyses of the fks1 and fks2 hotspots of the C. glabrata revealed no mutations except in 2 of these 3 isolates (L628R and S629P in fks1). Compared with previous surveillance performed in 1998-2001, there was a decrease in proportion of candidemia due to C. albicans (58 to 42%) and an increased proportion due to C. glabrata (20 to 36%). Further emergence of echinocandin resistance among the increasingly common species C. glabrata would complicate the management of this life-threatening infection.

KEYWORDS:

Antifungal resistance; Bloodstream infection; Candida; Echinocandin; Surveillance

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