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Journal of Clinical Microbiology, May 2006, p. 1681-1685, Vol. 44, No. 5
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.5.1681-1685.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Epidemiology, Risk Factors, and Prognosis of Candida parapsilosis Bloodstream Infections: Case-Control Population-Based Surveillance Study of Patients in Barcelona, Spain, from 2002 to 2003

Benito Almirante,1* Dolors Rodríguez,1 Manuel Cuenca-Estrella,2 Manel Almela,3 Ferran Sanchez,4 Josefina Ayats,5 Carles Alonso-Tarres,6 Juan L. Rodriguez-Tudela,2 Albert Pahissa,1 and the Barcelona Candidemia Project Study Group

Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain,1 Mycology Department, Instituto de Salud Carlos III, Madrid, Spain,2 Microbiology Department, Hospital Clinic-IDIBAPS, Barcelona, Spain,3 Microbiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain,4 Microbiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain,5 Microbiology Department, Hospital General de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain6

Received 7 January 2006/ Returned for modification 22 February 2006/ Accepted 28 February 2006

Candida parapsilosis has emerged as an important yeast species causing fungemia. We describe the incidence and epidemiology of C. parapsilosis fungemia. Data from active population-based surveillance in Barcelona, Spain, from January 2002 to December 2003 were analyzed. We focused on 78 episodes of C. parapsilosis fungemia, and we compared them with 175 Candida albicans controls. C. parapsilosis accounted for 23% of all fungemias. The annual incidences were 1 episode per 105 patients, 1.2 episodes per 104 discharges, and 1.7 episodes per 105 patient days. All isolates but one (99%) were fluconazole susceptible. Seventy-two isolates (92%) were inpatient candidemias. Forty-two episodes (51%) were considered catheter-related fungemia, 35 (45%) were considered primary fungemia, and 3 (4%) were considered secondary fungemia. Risk factors for candidemia were vascular catheterization (97%), prior antibiotic therapy (91%), parenteral nutrition (54%), prior surgery (46%), prior immunosuppressive therapy (38%), malignancy (27%), prior antifungal infection (26%), transplant recipient (16%), neutropenia (12%), and prior colonization (11%). Multivariate analysis of the differential characteristics showed that the factors that independently predicted the presence of C. parapsilosis fungemia were neonate patients (odds ratio [OR], 7.5; 95% confidence interval [CI], 2.1 to 26.8; P = 0.002), transplant recipients (OR, 9.2; 95% CI, 1.9 to 43.3; P = 0.005), patients with a history of prior antifungal therapy (OR, 5.4; 95% CI, 1.8 to 15.9; P = 0.002), and patients who received parenteral nutrition (OR, 2.2; 95% CI, 1.09 to 4.6; P = 0.028). The overall mortality rate was lower than that associated with C. albicans candidemia (23% versus 43%; P < 0.01). In summary, C. parapsilosis was responsible for 23% of all candidemias and was more frequent in neonates, in transplant recipients, and in patients who received parenteral nutrition or previous antifungal therapy, mainly fluconazole. The mortality rate was lower than that associated with C. albicans fungemia.

* Corresponding author. Mailing address: Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain. Phone: 34-93-2746090. Fax: 34-93-4282762. E-mail: balmirante{at}vhebron.net.

Journal of Clinical Microbiology, May 2006, p. 1681-1685, Vol. 44, No. 5
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.5.1681-1685.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



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