Prevalence of Candida species in different hospital wards and their susceptibility to antifungal agents: results of a three year survey.

Over a three years period, 472 Candida isolates were obtained from specimens of patients hospitalized either in "at risk", Bone Marrow Transplant Unit and Intensive Care Unit, or in conventional wards, Pneumological Divisions of the "Binaghi" Hospital of Cagliari (Italy). Antifungal susceptibility profile to amphotericin B, voriconazole, fluconazole and ketoconazole was determined. Candida albicans was the predominant species while Candida krusei was the most frequent non-albicans species. C. krusei was significantly more common among Bone Marrow Transplant Unit and Intensive Care Unit than Pneumological Divisions patients (17.9% and 14.1% vs. 6.0%; p < 0.05). No significant differences were observed when the same distribution was analysed with regard to the other Candida species or when Bone Marrow Transplant Unit and Intensive Care Unit were compared. The profiles of susceptibility to the antifungal drugs among isolates from the different hospital wards showed no significant differences, even though most of MIC values were higher for Intensive Care Unit isolates compared to those for Bone Marrow Transplant Unit and Pneumological Divisions. For C. albicans isolates, amphotericin B was the more efficient antifungal (97.7% S), while fluconazole (6.1% R [Resistant] and 2.6% SDD [Susceptible Dose Dependent]) and ketoconazole (4.1% R and 3.2% SDD) showed the lowest activity. Voriconazole was the more efficient antimycotic for C. krusei (96.7% S) and Candida glabrata (100% S [Sensible]) isolates. This study has shown a significantly higher presence of non-albicans Candida in at risk wards as well as a decreased susceptibility to the older azoles (ketoconazole and fluconazole) among C. albicans isolates.