Abstract

Abstract
We analyzed the different Candidae species isolated from bloodstream infections and the related antifungal
susceptibility pattern over a five-year period (2007-2011) at Policlinico Umberto I of Rome (Italy).
The overall incidence of candidaemia during this range of time accounted for 6.4% with a marked increase from
2007 to 2011 (from 3.83% to 9%). The species isolated were the following: C. albicans (42%) and non-albicans (58%).
In the period 2007-2009, C.krusei was the most frequent species detected among non-albicans species (29.4%),
followed by C.glabrata (20%), whereas during 2010-2011 we found a shift versus C. parapsilosis increasing from 4.6%
to 33%.
C.albicans showed a good susceptibility to the most antifungal agents. C. krusei exhibited a raising resistance to
flucytosin and fluconazole. As for fluconazole, it shows an intrinsic resistance. In C. glabrata we observed increased
resistance especially to fluconazole for which this species shows a Susceptibility Dose-Dependent (SDD). C.tropicalis
had only a resistance to fluconazole (MIC 90%=16 mcg/ml) In vitro activity of the echinocandins resulted to be very
strong for all Candidae species. These drugs have a fungicidal activity and their use is recommended in the most
severe diseases.
Our study confirms the high incidence of candidaemia in the setting of critically ill patients. A strong association of
Candidae infection with the presence of Central Venous Catheter (CVC) has been markedly noticed especially in the
years 2009 and 2011 due to a greater use of CVC in our patients. The overall rate of resistance increased over the
study period in all Candidae strains.

Keywords: C. albicans and non-albicans; Candidaemie; Antimycotic agents susceptibility; Azoles; Echinocandins; Central Venous Catheter (CVC)