Prospective study of Candida species in patients at a comprehensive cancercenter

Since most nosocomial systemic yeast infections arise from the endogenous f lora of the patient,,ve prospectively evaluated the species stratification and antifungal susceptibility profile of Candida spp. associated with heavy colonization and systemic infection in patients at Memorial Sloan-Ketterin g Cancer Center in New York. A total of 349 Candida isolates were obtained from 223 patients during the later half of 1998. Cancer was the most common underlying disease, occurring in 91% of the patients, including 61.8%, wit h organ and 23.7% with hematological malignancies; 4.4% of the patients had AIDS. Candida albicans was the predominant species (67.3%); among 114 non- albicans Candida spp., C. glabrata (45.6%) was the most frequent, followed by C. tropicalis (18.4%), C. parapsilosis (16.6%), and C. krusei (9.6%). Th e overall resistance to triazole based agents among all yeast isolates was 9.4 and 10.8% for fluconazole and itraconazole, respectively. A total of 5% of C. albicans strains were resistant to triazole antifungals, whereas 30. 8 and 46.2% of C. glabrata strains were resistant to fluconazole (MIC great er than or equal to 64 mug/ml) and itraconazole (MIC greater than or equal to 1 mug/ml), respectively. A significant association was observed between prior treatment with triazole and isolation of fluconazole-resistant C. alb icans (P = 0.005, OR 36), although this relationship was not seen in C. gla brata isolates (P = 0.4). This study reinforces the importance of periodic, prospective surveillance of clinical fungal isolates to determine appropri ate prophylactic, empiric, and preemptive antifungal therapy far the highly susceptible patient population.