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Are there changes in candidemia epidemiology and

Are there changes in candidemia epidemiology and susceptibility profile in 7 Belgian hospitals after a 5 year period ?

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Are there changes in candidemia epidemiology and

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  1. Are there changes in candidemiaepidemiologyand susceptibility profile in 7 Belgianhospitalsafter a 5 yearperiod? C. Van Laer1*,2, K. Lagrou2, P. Vandecandelaere3*, AM. Van den Abeele4*, J. Frans5*, R. Cartuyvels6*, E. Oris7*, H. De Beenhouwer1*, K. Van Vaerenbergh1*, A. Boel1*1 OLV Hospital, Aalst, 2 University Hospitals Leuven, Leuven, 3 Jan YpermanHospital, Ieper, 4 Sint-Lucas Hospital, Ghent, 5ImeldaHospital, Bonheiden, 6JessaHospital, Hasselt, 7HospitalZuid-OostLimburg, Genk; Belgium. *On behalf of the BILULU studygroup. Results Introduction The aim of this study was to evaluate susceptibilities of all yeasts isolated from blood cultures during a 9 month period in 7 Belgian hospitals. The obtained susceptibility results were compared with those from a study 5 years ago in the same hospitals where the susceptibility of 84 yeasts, isolated from December 2004 till June 2005, was determined. Species distribution for the 106 isolates was: 56 Candida albicans strains, 35 C. glabrata, 8 C. parapsilosis, 2 C. tropicalis, 1 C. krusei, 1 C. kefyr, 1 C. dubliniensis, 1 Trichosporon species and 1 Cryptococcus neoformans(fig 1). In comparison with the previous study, a shift from C. albicans (63%  53%) to C. glabrata (21%  33%) was observed. C. albicans (n=56) allyeasts (n=106) C. glabrata (n=35) Materials and methods Fig 1: Species distribution of allyeastsisolatedfromblood cultures • From December 2010 till August 2011, all yeasts isolated from blood cultures (n=106, no duplicates) were collected in 7 Belgian hospitals: • OnzeLieveVrouw Hospital, Aalst (n=11) • University Hospitals Leuven, Leuven (n=56) • Jan Yperman Hospital, Ieper (n=8) • Sint-Lucas Hospital, Ghent (n=5) • Imelda Hospital, Bonheiden (n=6) • Jessa Hospital, Hasselt (n=10) • Hospital Zuid-Oost Limburg, Genk (n=10) • All isolates were identified to species level by ITS2 fragment length analysis. Susceptibility testing was performed in one centre on RPMI agar (AES ChemunexLaboratoire, BruzCedex, France) with E-test (Etest® BioMérieux, Marcy-l’Etoile, France) for fluconazole, voriconazole, caspofungin and amphotericin B. • Results were interpreted following CLSI M27-S3 guidelines and ATCC 22019 C. parapsilosis and ATCC 6258 C. krusei were used as QC (2). Overall MIC distribution was obtained (fig 2). All C. albicans strains remained susceptible to fluconazole, voriconazole and caspofungin, with MIC values (in µg/mL) respectively from 0,038 to 0,75 (MIC90: 0,38), from 0,003 to 0,064 (MIC90: 0,012) and from 0,008 to 0,32 (MIC90: 0,125). For amphotericin B MIC ranges varied from 0,002 to 1 (MIC90: 0,5). Fig 2: MIC distributions for fluconazole, voriconazole, caspofungin and amphotericin B of allyeasts, C. albicansand C. glabrata isolates fromblood cultures (12/’04-06/’05 vs. 12/’10-08/’11) Of 35 C. glabrata strains, 21 strains were susceptible to fluconazole (MIC ranges 3-8, MIC90: 8), 12 strains SDD (MIC ranges 12-24, MIC90: 24) and 2 strains resistant (MIC >256). The MIC values for voriconazole were 0,032-0,75 for fluconazole susceptible strains, 0,25-0,5 for fluconazole SDD strains and 3-8 for fluconazole resistant strains. All strains were susceptible to caspofungin with MIC values of 0,008-0,25 (MIC90: 0,19). The MIC values for amphotericin B ranged from 0,002 to 1 (MIC90: 0,75). MIC distributions are shown in fig 2. All C. parapsilosis strains were susceptible to fluconazole (MIC 0,25-1, MIC90: 1) and voriconazole (MIC 0,008-0,064, MIC90: 0,032). MIC distributions for caspofungin were 0,25-1,5 (MIC90: 1), for amphotericin B 0,38-1 (MIC90: 1). References BoelA. et al, Susceptibility of yeasts isolated from hemocultures in 7 Belgian hospitals, Poster ISHAM 2006 CLSI Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts; 3th Informational Supplement, M27-S3, vol 28 n°15 Acknowledgement: The authors thank Pfizer for the supply of materials for susceptibility testing: E-test and RPMI agars. contact: christine.1.vanlaer@uzleuven.be Conclusions Compared with our data from 5 years ago, we observed no significant changes in resistance patterns. Although there seemed to be a shift in species distribution, confirmation with more data is needed.

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