Heterogeneity of Candida bloodstream isolates in an academic medical center and affiliated hospitals

Abstract

Candida species are an important cause of hospital-acquired infection. The prevalence of species causing infections and the frequency of antifungal drug resistance have changed over time. Reporting the regional Candida species distribution and phenotypes has clinical significance. Current clinical microbiology practices may underestimate the within-host diversity of infecting strains, including important variation in drug susceptibility. Our study reports the results of an 18-month survey of Candida bloodstream infections in an academic medical center and associated hospitals in the Minneapolis-Saint Paul region of Minnesota. We identified antifungal drug resistance, including multidrug resistance, in multiple non-albicans species. By analyzing serial isolates from individual patients, we identified clinically relevant differences in drug susceptibility during infection. Our results contribute data to antifungal stewardship efforts and identify avenues of future research.