Knowledge of susceptibility patterns and the species causing candidemia is useful in guiding empirical antifungal treatment and monitoring trends. We performed a retrospective analysis of candidemia from 2005-2009 (group 1) compared to 2010-2014 (group 2) at Royal Perth Hospital, which has a case mix including bone marrow transplantation, solid organ transplantation, burns and intensive care. Group 1 had 79 separate episodes of candidemia representing 0.15% (79/50070) of all blood cultures received, while group 2 had 87 episodes representing 0.12% (87/70502) of all blood cultures received . There was no significant difference between the two time periods in the causative species expressed as a percentage of the total candidemias (p=0.563), group 1 versus group 2: Candida albicans 48.1% vs 37.9%, Candida glabrata 27.8% vs 34.5%, Candida parapsilosis 13.9% vs 13.8%.
For those isolates tested, no significant differences in antifungal resistance rates were identified for group 1 versus group 2 as follows. Candida albicans: fluconazole intermediate (I) or resistant (R) 0% (0/3) vs 14.3% (1/7), p=1.000; caspofungin I/R 0% (0/3) vs 14.3% (1/7), p=1.000. Candida glabrata: fluconazole R 27.3% (3/11) vs 15% (3/20), p=0.638; caspofungin I/R 9.1% (1/11) vs 5% (1/20) p=1.000. Candida parapsilosis: fluconazole I/R 0% (0/8) vs 0% (0/4), p=1.000; caspofungin I/R 0% (0/8) vs 0% (0/4), p=1.000.
Examining the data overall, fluconazole remains an appropriate choice of antifungal treatment for C. albicans (10.0% I/R of those 10 isolates tested) and C. parapsilosis (0% I/R of 12 isolates tested) candidemia, and we identified very few isolates with elevated caspofungin MIC: 8.1% (5/62) of all candidemia, 6.5% (2/31) of C. glabrata, 0% (0/12) of C. parapsilosis. We found no major changes in antifungal susceptibilities or causative species of candidemia over time.