Monash Infectious Diseases participated in this study coordinated by the Australian and New Zealand Mycoses Interest Group (ANZMIG), a special interest group (SIG) of the Australasian Society for Infectious Diseases (ASID).


Publications

Active surveillance for candidemia, Australia.
Chen S, Slavin M, Nguyen Q, Marriott D, Playford EG, Ellis D, Sorrell T; Australian Candidemia Study.
Emerg Infect Dis. 2006 Oct;12(10):1508-16.
PMID: 17176564 [PubMed – indexed for MEDLINE]
Abstract. Population-based surveillance for candidemia in Australia from 2001 to 2004 identified 1,095 cases. Annual overall and hospital-specific incidences were 1.81/100,000 and 0.21/1,000 separations (completed admissions), respectively. Predisposing factors included malignancy (32.1%), indwelling vascular catheters (72.6%), use of antimicrobial agents (77%), and surgery (37.1%). Of 919 episodes, 81.5% were inpatient healthcare associated (IHCA), 11.6% were outpatient healthcare associated (OHCA), and 6.9% were community acquired (CA). Concomitant illnesses and risk factors were similar in IHCA and OHCA candidemia. IHCA candidemia was associated with sepsis at diagnosis (p<0.001), death <30 days=”” after=”” infection=”” p=”0.02).” 0=”” 001=”” and=”” prolonged=”” hospital=”” admission=”” non-candida=”” albicans=”” species=”” 52=”” 7=”” caused=”” 60=”” 5=”” of=”” cases=”” acquired=”” outside=”” hospitals=”” 49=”” 9=”” ihca=”” candidemia=”” the=”” 30-day=”” death=”” rate=”” was=”” 27=”” in=”” those=””> or =65 years of age. Adult critical care stay, sepsis syndrome, and corticosteroid therapy were associated with the greatest risk for death. Systematic epidemiologic studies that use standardized definitions for IHCA, OHCA, and CA candidemia are indicated.

Not just little adults: candidemia epidemiology, molecular characterization, and antifungal susceptibility in neonatal and pediatric patients.
Blyth CC, Chen SC, Slavin MA, Serena C, Nguyen Q, Marriott D, Ellis D, Meyer W, Sorrell TC; Australian Candidemia Study.
Pediatrics. 2009 May;123(5):1360-8. doi: 10.1542/peds.2008-2055.
PMID: 19403503 [PubMed – indexed for MEDLINE]
OBJECTIVE:The purpose of this work was to identify differences in incidence, risk factors, microbiology, treatment, and clinical outcome of candidemia in neonates, children, and adults that might impact on management.
PATIENTS AND METHODS: Cases of candidemia in Australia were identified prospectively by blood culture surveillance over 3 years. Episodes of candidemia in neonatal, pediatric, and adult age groups were analyzed and compared.
RESULTS: Of 1005 incident cases, 33 occurred in neonates, 110 in children, and 862 in adults. The respective annual age-specific incidences were 4.4, 0.9, and 1.8 per 100,000 population. Prematurity and ICU admission were major risk factors in neonates. Hematologic malignancy and neutropenia were significantly more frequent in children than in neonates and adults. Diabetes, renal disease, hemodialysis, and recent surgery were more common in adults. Candidemia was attributed to a vascular access device in 58% of neonates, 70% of children, and 44% of adults. Candida albicans caused approximately 48% of cases in all of the age groups. Candida parapsilosis was significantly more common in neonates and children (42% and 38% vs 15%). Candida glabrata was infrequent in neonates and children (9% and 3% vs 17%). Significantly more isolates from children were susceptible to fluconazole compared with those from adults (95% vs 75%). Fluconazole-resistant candidal isolates were infrequent in all of the age groups. Neonates and children were more likely to receive amphotericin B compared with adults. Adults were more likely to receive fluconazole. Survival rates at 30 days were 78% in neonates, 90% in children, and 70% in adults.
CONCLUSIONS: This study identifies significant differences in candidemia in neonates, children, and adults. Neonatologists and pediatricians must consider age-specific differences when interpreting adult studies and developing treatment and prevention guidelines.

Candidemia following solid organ transplantation in the era of antifungal prophylaxis: the Australian experience.
van Hal SJ, Marriott DJ, Chen SC, Nguyen Q, Sorrell TC, Ellis DH, Slavin MA; Australian Candidaemia Study.
Transpl Infect Dis. 2009 Apr;11(2):122-7. doi: 10.1111/j.1399-3062.2009.00371.x. Epub 2009 Apr 7. PMID: 19220822 [PubMed – indexed for MEDLINE]
Abstract. Solid organ transplant (SOT) recipients have high rates of invasive fungal infections, with Candida species the most commonly isolated fungi. The aim of this study was to identify differences between incidence rates, risk factors, clinical presentations, and outcomes of candidemia in SOT recipients and non-SOT patients. Data from the multicenter prospective Australian Candidaemia Study were examined. From August 2001 to July 2004, 24 episodes (2.2%; 24/1068) of candidemia were identified in SOT recipients. During this period, the numbers of transplanted organs included liver (n=455), kidney (n=1605), single lung (n=57), bilateral lung (n=183), heart and lung (n=18), heart (n=157), and pancreas (n=62). The overall annual estimated incidence of candidemia in SOT recipients was higher (3 per 1000 transplant admissions) than in non-SOT patients (incidence 0.21 per 1000 admissions; P<0.001). The incidence and timing of candidemia post transplant was influenced by the transplanted organ type, with the majority of episodes (n=14, 54%) occurring >6 months after renal transplantation. Risk factors for candidemia in the month preceding diagnosis were similar to non-SOT recipients except for corticosteroid therapy (P<0.001). Antifungal prophylaxis did not select for more resistant or non-albicans Candida species in the SOT group. The 30-day all-cause mortality was similar to non-SOT patients with candidemia and remains high at 21%. All deaths in SOT recipients occurred early (within 5 days of diagnosis), underlining a need for better diagnostic tests, targeted prevention, and early treatment strategies.

Candidaemia with uncommon Candida species: predisposing factors, outcome, antifungal susceptibility, and implications for management.
Chen SC, Marriott D, Playford EG, Nguyen Q, Ellis D, Meyer W, Sorrell TC, Slavin M; Australian Candidaemia Study.
Clin Microbiol Infect. 2009 Jul;15(7):662-9. doi: 10.1111/j.1469-0691.2009.02821.x. Epub 2009 Jul 15.
PMID: 19614718 [PubMed – indexed for MEDLINE]
Abstract. The risk factors for and clinical features of bloodstream infection with uncommon Candida spp. (species other than C. albicans, C. glabrata, C. parapsilosis, C. tropicals and C. krusei) are incompletely defined. To identify clinical variables associated with these species that might guide management, 57 cases of candidaemia resulting from uncommon Candida spp. were analysed in comparison with 517 episodes of Candida albicans candidaemia (2001-2004). Infection with uncommon Candida spp. (5.3% of candidaemia cases), as compared with C. albicans candidaemia, was significantly more likely to be outpatient-acquired than inpatient-acquired (15 of 57 vs. 65 of 517 episodes, p 0.01). Prior exposure to fluconazole was uncommon (n=1). Candida dubliniensis was the commonest species (n=22, 39%), followed by Candida guilliermondii (n=11, 19%) and Candida lusitaniae (n=7, 12%).C. dubliniensis candidaemia was independently associated with recent intravenous drug use (p 0.01) and chronic liver disease (p 0.03), and infection with species other than C. dubliniensis was independently associated with age<65 years=”” p=”” 0=”” 02=”” male=”” sex=”” 03=”” and=”” human=”” immunodeficiency=”” virus=”” infection=”” 05=”” presence=”” of=”” sepsis=”” at=”” diagnosis=”” crude=”” 30-day=”” mortality=”” rates=”” were=”” similar=”” for=”” c=”” dubliniensis-related=”” non-c=”” albicans-related=”” candidaemia=”” haematological=”” malignancy=”” was=”” the=”” commonest=”” predisposing=”” factor=”” in=”” guilliermondii=”” n=”3,” 27=”” lusitaniae=”” 43=”” rate=”” higher=”” than=”” overall=”” death=”” all=”” uncommon=”” candida=”” spp=”” 42=”” 9=”” vs=”” 25=”” not=”” significant=”” isolates=”” susceptible=”” to=”” amphotericin=”” b=”” voriconazole=”” posaconazole=”” caspofungin=”” five=”” strains=”” had=”” fluconazole=”” mic=”” values=”” 16-32=”” mg=”” l=”” due=”” is=”” emerging=”” among=”” hospital=”” outpatients=”” certain=”” clinical=”” variables=”” may=”” assist=”” recognition=”” this=”” entity=”” br=””>
Candidaemia in adult cancer patients: risks for fluconazole-resistant isolates and death.
Slavin MA, Sorrell TC, Marriott D, Thursky KA, Nguyen Q, Ellis DH, Morrissey CO, Chen SC; Australian Candidemia Study, Australasian Society for Infectious Diseases.
J Antimicrob Chemother. 2010 May;65(5):1042-51. doi: 10.1093/jac/dkq053. Epub 2010 Mar 4.
PMID: 20202987 [PubMed – indexed for MEDLINE]
BACKGROUND: Candidaemia in cancer patients is associated with increasing fluconazole resistance. Models for predicting such isolates and their clinical impact are required.
METHODS: Clinical, treatment and outcome data from a population-based candidaemia survey (2001-2004) were collected at 5 and 30 days after diagnosis. Speciation and antifungal susceptibility testing was performed.
RESULTS: There were 138 candidaemia episodes (33% Candida albicans) in adults with haematological malignancies and 150 (51% C. albicans) in adults with solid organ malignancies. Thirty-nine isolates had fluconazole MICs of >or=64 mg/L and 40 had MICs of 16-32 mg/L (predominantly Candida glabrata and Candida krusei). By multivariate analysis, triazole therapy, gastrointestinal tract (GIT) surgery in the 30 days before candidaemia and age >65 years were predictive of fluconazole-resistant candidaemia. Thirty day crude mortality was 40% in haematology patients and 45% in oncology patients. Fluconazole-resistant isolates were associated with increased risk of mortality by univariate (P = 0.04) and Kaplan-Meier survival analyses. By Cox proportional hazards modelling, the strongest predictors of mortality at onset of candidaemia were invasive ventilation, elevated creatinine, intensive care unit (ICU) admission and receipt of systemic triazoles or corticosteroids in the previous 30 days. Removal of a central venous access device (CVAD) at or within 5 days of onset was associated with decreased mortality.
CONCLUSIONS: Risk factors for fluconazole-resistant candidaemia in adults with cancer include fluconazole/triazole exposure and GIT surgery. ICU admission, invasive ventilation, renal impairment, age >65 years and prior exposure to corticosteroids and triazoles are risk factors for death. CVAD removal reduced mortality. These findings should be integrated into surveillance and treatment algorithms.

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