Zur Situation invasiver Candidosen in Deutschland

Zur Situation invasiver Candidosen in Deutschland

Epidemiologie, Resistenzverhalten und klinisch-geographische Besonderheiten

About situation of invasive candidiasis in germany

epidemiology, resistance behavior and clinical geographic particularities

Daniel Kahl

Doctoral thesis

Date of Examination: 2015-09-09

Date of issue: 2015-09-02

Advisor: Borg-von Zepelin, Margarete Prof. Dr. Dr.

Referee: Mörer, Onnen Prof. Dr.

Referee: Spreer, Annette PD Dr.

Persistent Address: http://hdl.handle.net/11858/00-1735-0000-0023-3DA0-D

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Abstract

English

657 candida isolates of primary sterile materials of 63 MykolabNet-D member institutes from september 2005 to december 2006 were analysed regarding the nationwide epidemiology, resistance behavior and local and geographic particularities. C. albicans was the dominating species with about 62%, followed by the Non-albicans species (NAC) C. glabrata (18,3%), C.tropicalis (6,1%), C. parapsilosis (5,3%) and C. krusei (2,6%). 68% were blood culture isolates. The most important risk factor was intensive care therapy. 58% of patients were men with an average age of 61 years. C. glabrata- and C. tropicalis-infections seemed to be associated with higher, C. parapsilosis and C. krusei with lower age. Using the CLSI-Standard M27 A2 for broth microdilution testing we analysed sensitivity and MIC90 towards amphotericine B, flucytosine, fluconazole, itraconazole, voriconazole and caspofungine. All isolates were sensitive towards amphothericine, MIC90 was 1,0µg/ml. 91,5%, of the isolates were sensitive towards flucytosine, MIC90 was <0,125 µg/ml. 95,8%, 28,5% and 98,8% of the isolates were sensitive towards fluconazole, itraconazole and voriconazole, MIC90 were 4,0µg/ml, 1,0 µg/ml and 0,125 µg/ml. The sensitivity towards caspofungine was 78,2%, MIC90 0,5µg/ml. We also analysed differences in species distribution and resistance between new and old german states, university and peripheral hospitals and at last different institutions: NAC rate and resistance was significantly higher in the new german states and university hospitals. But the biggest bandwidth we found in the interinstitutional comparison: The rate of C. albicans and C. glabrata differ about 26 and 24%. Local accumulation of resistant strains and species also resulted in strongly differing resistance samples for flucytosine (0-20% resistant C.albicans), fluconazole (0-14% resistant C.glabrata) and caspofungine (0-57% resistant. C.glabrata). The knowledge of the local epidemiology and resistance behavior seems to be imperative for an effective empirical therapy.

Keywords: candidiasis; candidemia; epidemiology; resistance behavior

Schlagwörter: invasive Candidiasis; Candidämie; Epidemiologie; Resistenzverhalten