146 - Antifungal Susceptibility Patterns of Candida Parapsilosis Bloodstream Isolates in the US, 2008-2018

Background: Multidrug resistant Candida is an increasing concern. C. parapsilosis in particular has decreased in vitro susceptibility to echinocandins. As a result, fluconazole had been favored for C. parapsilosis treatment. However, there is growing concern about increasing azole resistance among Candida species. We report on antifungal susceptibility patterns of C. parapsilosis in the US from 2008 through 2018.

Methods: Active, population-based surveillance for candidemia through the Centers for Disease Control and Prevention’s (CDC) Emerging Infections Program was conducted between 2008-2018, eventually encompassing 9 states (GA, MD,OR, TN, NY, CA, CO, MN, NM). Each incident isolate was sent to the CDC for species confirmation and antifungal susceptibility testing (AFST). Frequency of resistance was calculated and stratified by year and state using SAS 9.4

Results: Of the 8,704 incident candidemia isolates identified, 1,471 (15%) were C. parapsilosis; the third most common species after C. albicans and C. glabrata. AFST results were available for 1,340 C. parapsilosis isolates. No resistance was detected to caspofungin (MIC₅₀ 0.25) or micafungin (MIC₅₀ 1.00) with only one (< 1%) isolate resistant to anidulafungin (MIC₅₀ 1.00). In contrast, 84 (6.3%) isolates were resistant to fluconazole and another 44 (3.3%) isolates had dose-dependent susceptibility to fluconazole (MIC₅₀ 1.00). Fluconazole resistance increased sharply from an average of 4% during 2008-2014 to a peak of 14% in 2016 with a subsequent decline to 6% in 2018 (see figure). Regional variation is also observed with fluconazole resistance ranging from 0% (CO, MN, NM) to 42% (NY) of isolates by site.Fluconazole resistance in C. parapsilosis, 2008-2018


Conclusion: The recent marked increase in fluconazole resistance among C. parapsilosis highlights this pathogen as an emerging drug resistant pathogen of concern and the need for ongoing antifungal resistance surveillance among Candida species. Our data support the empiric use of echinocandins for C. parapsilosis bloodstream infections and underscore the need to obtain AFST prior to fluconazole treatment. Furthermore, regional variation in fluconazole resistance emphasizes the importance of understanding local Candida susceptibility patterns.

Presenting Author(s)

• 

  Brenda L. Tesini, MD

  Assistant Professor
  New York Emerging Infections Program University of Rochester
  Rochester, NY

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

  Slides Slides and Audio

Co-Author(s)

• ML

  Meghan Lyman, MD

  Medical Epidemiologist
  CDC
  Atlanta, Georgia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• BJ

  Brendan R. Jackson, MD, MPH

  Medical Epidemiologist
  Centers for Disease Control and Prevention
  Atlanta, Georgia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• AG

  Anita Gellert, BSN

  Ms
  University of Rochester
  Rochester, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• WS

  William Schaffner, MD

  Professor of Preventive Medicine
  Vanderbilt University
  Nashville, Tennessee

  Disclosure: No Disclosure
• MF

  Monica M. Farley, MD

  Professor
  Emory University
  Atlanta, Georgia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• SS

  Sarah Shrum, MPH

  coordinator
  New Mexico Emerging Infectious Program
  Albuquerque, New Mexico

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• EP

  Erin C. Phipps, DVM, MPH

  Principal Investigator, CDI/MuGSI/Candidemia Surveillance
  University of New Mexico
  Albuquerque, New Mexico

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• AZ

  Alexia Y. Zhang, MPH

  Epidemiologist
  Oregon Public Health Division-Acute and Communicable Disease Prevention
  Portland, Oregon

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• BP

  Brittany Pattee, MPH

  Epidemiologist
  Minnesota Department of Health
  St. Paul, Minnesota

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• JF

  Jill Fischer, MT/ASCP

  Bacteriology Laboratory Specialist
  Minnesota Department of Health
  St. Paul, Minnesota

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• HJ

  Helen Johnston, MPH

  Emerging Infections Unit Manager
  Colorado Department of Public Health and Environment
  Denver, Colorado

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• DB

  Devra Barter, MS

  Emerging Infections Epidemiologist
  Colorado Department of Public Health and Environment
  Denver, Colorado

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• LH

  Lee Harrison, MD

  Head, Infectious Diseases Epidemiology Research Unit
  University of Pittsburgh
  Pittsburgh, Pennsylvania

  Disclosure: GSK: Consultant; Merck: Consultant; Pfizer: Consultant; Sanofi Pasteur: Consultant
• KM

  Kaytlynn Marceaux, MPH

  research assistant
  Johns Hopkins University
  Baltimore, Maryland

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• JN

  Joelle Nadle, MPH

  Project Coordinator
  California Emerging Infections Program
  Oakland, California

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.